Drug Selection, Dosage Adjustment, and Potential Interaction of Antihypertensive and Antidiabetic for Chronic Kidney Disease with Hemodialysis
Abstract
Antihypertensive and antidiabetic drugs in CKD patients on hemodialysis may cause medication-related problems requiring monitoring. This study aimed to evaluate the selection, dosage, and potential drug interactions of antihypertensive and antidiabetic drugs in stage 5 CKD patients with hypertension and/or type 2 diabetes mellitus undergoing hemodialysis in a hospital in Jakarta. A crosssectional study used the medical records of adult in patients from January - December 2022 with a total sampling method. Out of 101 patients, 97.0% received appropriate drug selection. Dosage adjustments were appropriate in 74.3% of cases. Potential drug interactions between antihypertensive and antidiabetic drugs were found in 90.1% of patients, mostly pharmacodynamic interactions, moderate severity, and requiring monitoring. Statistical analysis showed that age, gender, number of drugs, and length of stay were not associated with the appropriateness of antihypertensive and antidiabetic drug selection (p>0.05). However, there was a relationship between number of drugs (p=0.033; OR=2.996) and length of stay (p=0.024; OR=3.171) with the appropriateness of drug dosage. The length of stay was also associated with potential drug interactions (p=0.040; OR=8.426). Drug selection has been done well, but there is a need for improvement in monitoring dosage adjustments and potential drug interactions by pharmacists in the hospital.
References
1. Gliselda VK. Diagnosis dan manajemen penyakit ginjal kronis (PGK). Jurnal Medika Hutama. 2021;2(04 Juli):1135-41.
2. Rossing P, Caramori ML, Chan JC, Heerspink HJ, Hurst C, Khunti K, et al. KDIGO 2022 clinical practice guideline for diabetes management in chronic kidney disease. Kidney International. 2022;102(5):S1-S127.
3. de Souza W, de Abreu LC, Silva LGd, Bezerra IMP. Incidence of chronic kidney disease hospitalisations and mortality in Espírito Santo between 1996 to 2017. PLoS One. 2019;14(11):e0224889. PLoS One. 2019;14(11):e0224889.
4. Riskesdas LN. Kementerian Kesehatan Republik Indonesia. Badan Penelitian Dan Pengembangan Kesehatan. 2018.
5. Matsushita K, Mahmoodi BK, Woodward M, Emberson JR, Jafar TH, Jee SH, et al. Comparison of risk prediction using the CKD-EPI equation and the MDRD study equation for estimated glomerular filtration rate. Jama. 2012;307(18):1941-51.
6. Jalalonmuhali M, Lim SK, Md Shah MN, Ng KP. MDRD vs. CKD-EPI in comparison to 51Chromium EDTA: a cross sectional study of Malaysian CKD cohort. BMC nephrology. 2017;18(1):1-6.
7. Hunter-Dickson M, Drak D, Anderson M, Shamu T, Chimbetete C, Dahwa R, et al. Comparison of CG, CKD-EPI [AS] and CKD-EPI [ASR] equations to estimate glomerular filtration rate and predict mortality in treatment naïve people living with HIV in Zimbabwe. BMC nephrology. 2023;24(1):1-6.
8. Cahyani AAAE, Prasetya D, Abadi MF, Prihatiningsih D. Gambaran diagnosis pasien pra-hemodialisa di RSUD Wangaya Tahun 2020-2021. Jurnal Ilmiah Hospitality. 2022;11(1):661-6.
9. Pernefri PNI. Konsensus dialisis. Jakarta: Pernefri. 2003. 21–34.
10. Putra IGSS, Islamiah A. Gambaran klinis dan laboratoris penderita penyakit ginjal kronis yang menjalani hemodialisis di RSUD Muara Teweh, Barito Utara, Kalimantan Tengah. Intisari Sains Medis. 2023;14(1):538-42.
11. Indonesia PN. 11th Report of Indonesian renal registry 2018. Jakarta: Perhimpunan Nefrologi Indonesia. 2018;1–46.12.
12. Insani N, Manggau MA, Kasim H. Analisis efektivitas terapi pada pasien anemia gagal ginjal hemodialisis di RSUP Dr. Wahidin Sudirohusodo Makassar. Majalah Farmasi dan Farmakologi. 2018;22(1):13-5.
13. Adusumilli P, Adepu R. Drug related problems: an over view of various classification systems. Asian J Pharm Clin Res. 2014;7(4):7-10.
14. Hepler CD, Strand LM. Opportunities and responsibilities in pharmaceutical care. American journal of hospital pharmacy. 1990;47(3):533-43.
15. Handayani N, Faisal M, Rusli R. Drug interaction studies in patients with kidney failure inpatient at Panglima Sebaya Hospital, Tanah Grogot. Jurnal Sains dan Kesehatan. 2023;5(4):500-6.
16. Tuloli TS, Madania M, Mustapa MA, Tuli EP. Evaluasi penggunaan obat pada pasien gagal ginjal kronik yang menjalani hemodialisis di RSUD Toto Kabila Periode 2017-2018. Parapemikir: Jurnal Ilmiah Farmasi. 2019;8(2):25-32.
17. Lucida H, Trisnawati R, Suardi M. Analisis aspek farmakokinetika klinik pasien gagal ginjal pada IRNA penyakit dalam RSUP Dr. M. Djamil Padang. Jurnal Sains Dan Teknologi Farmasi. 2011;16(2):144-55.
18. Zhao P, Vieira MdL, Grillo JA, Song P, Wu TC, Zheng JH, et al. Evaluation of exposure change of nonrenally eliminated drugs in patients with chronic kidney disease using physiologically based pharmacokinetic modeling and simulation. The Journal of Clinical Pharmacology. 2012;52(S1):91S-108S.
19. Rengga MPE, Kono RB, Beama CA. Analisis interaksi obat penyakit ginjal kronik di RSUD Prof. Dr. WZ Johannes Kupang. MPI (Media Pharmaceutica Indonesiana). 2021;3(3):179-87.
20. Ashley C, Dunleavy A. The renal drug handbook: the ultimate prescribing guide for renal practitioners: CRC Press; 2018.
21. Indonesia PE. Pedoman petunjuk praktis terapi insulin pada pasien diabetes mellitus 2021. Jakarta: PB PERKENI. 2021.
22. Kementrian Kesehatan Republik Indonesia. Pedoman nasional pelayanan kedokteran tata laksana diabetes melitus tipe 2 dewasa. Kementrian Kesehatan Republik Indonesia; 2020.
23. Kementrian Kesehatan Republik Indonesia. Pedoman nasional pelayanan kedokteran tata laksana hipertensi dewasa. Kementrian Kesehatan Republik Indonesia; 2021.
24. Zhao JV, Schooling CM. The role of testosterone in chronic kidney disease and kidney function in men and women: a bi-directional Mendelian randomization study in the UK Biobank. BMC medicine. 2020;18(1):1-10.
25. Denic A, Lieske JC, Chakkera HA, Poggio ED, Alexander MP, Singh P, et al. The substantial loss of nephrons in healthy human kidneys with aging. Journal of the American Society of Nephrology: JASN. 2017;28(1):313-20.
26. Dybiec J, Szlagor M, Młynarska E, Rysz J, Franczyk B. Structural and functional changes in aging kidneys. International Journal of Molecular Sciences. 2022;23(23):15435.
27. Shafiee MA, Chamanian P, Shaker P, Shahideh Y, Broumand B, editors. The impact of hemodialysis frequency and duration on blood pressure management and quality of life in end-stage renal disease patients. Healthcare; 2017;5(3):52.
28. Chauhan R, Mendonca S. Adequacy of twice weekly hemodialysis in end stage renal disease patients at a tertiary care dialysis centre. Indian journal of nephrology. 2015;25(6):329-33.
29. MacRae C, Mercer SW, Guthrie B, Henderson D. Comorbidity in chronic kidney disease: a large cross-sectional study of prevalence in Scottish primary care. British Journal of General Practice. 2021;71(704):e243-e9.30.
30. Garla V, Kanduri S, Yanes-Cardozo L, Lien LF. Management of diabetes mellitus in chronic kidney disease. Minerva Endocrinologica. 2019;44(3):273-87.
31. Hahr AJ, Molitch ME. Management of diabetes mellitus in patients with chronic kidney disease. Clinical diabetes and endocrinology. 2015;1(1):1-9.
32. Betônico CC, Titan SMO, Lira A, Pelaes TS, Correa- Giannella MLC, Nery M, et al. Insulin glargine U100 improved glycemic control and reduced nocturnal hypoglycemia in patients with type 2 diabetes mellitus and chronic kidney disease stages 3 and 4. Clinical therapeutics. 2019;41(10):2008-20. e3.
33. Kalaitzidis RG, Elisaf MS. Treatment of hypertension in chronic kidney disease. Current hypertension reports. 2018;20:1-10.
34. Sinha AD, Agarwal R. Clinical pharmacology of antihypertensive therapy for the treatment of hypertension in CKD. Clinical Journal of the American Society of Nephrology: CJASN. 2019;14(5):757-64.
35. Gregg LP, Richardson P, Herrera MA, Akeroyd J, Jafry S, Gobbel G, et al. Documented adverse drug reactions and discontinuation of angiotensin converting enzyme inhibitors and angiotensin receptor blockers in chronic kidney disease. American Journal of Nephrology. 2023;54(3-4):126-35.
36. Lexicomp. Drug Interactions Analysis: Wolters Kluwer; 2023.
37. Barbieri MA, Rottura M, Cicala G, Mandraffino R, Marino S, Irrera N, et al. Chronic kidney disease management in general practice: a focus on inappropriate drugs prescriptions. Journal of clinical medicine. 2020;9(5):1346.
38. Sharma R, Chhabra M, Vidyasagar K, Rashid M, Fialova D, Bhagavathula AS. Potentially inappropriate medication use in older hospitalized patients with type 2 diabetes: a Cross-sectional study. Pharmacy. 2020;8(4):219.
39. Youssef A, Almubarak A, Aljohnai M, Alnuaimi M, Alshehri B, Al-ghamdi G, et al. Contraindicated medications administered to inpatients with renal insufficiency in a Saudi Arabian hospital that has a computerized clinical decision support system. Journal of Taibah University Medical Sciences. 2015;10(3):320-6.
40. Fukuba N, Nishida M, Hayashi M, Furukawa N, Ishitobi H, Nagaoka M, et al. The relationship between polypharmacy and hospital-stay duration: a retrospective study. Cureus. 2020; 12(3): e726741.
41. Zeleke TK, Birhan TY, Abdela OA. Medicine dose adjustment practice and associated factors among renally impaired patients in Amhara Regional State, Ethiopia. International Journal of Nephrology. 2021;2021:1-9.
42. Saleem A, Masood I. Pattern and predictors of medication dosing errors in chronic kidney disease patients in Pakistan: a single center retrospective analysis. PLoS One. 2016;11(7):e0158677.
43. Dagnew EM, Ergena AE, Wondm SA, Sendekie AK. Potential drug-drug interactions and associated factors among admitted patients with psychiatric disorders at selected hospitals in Northwest Ethiopia. BMC Pharmacology and Toxicology. 2022;23(1):88.
44. Marquito AB, Fernandes NMdS, Colugnati FAB, Paula RBd. Identifying potential drug interactions in chronic kidney disease patients. Brazilian Journal of Nephrology. 2014;36:26-34.
45. Bhagavathula AS, Berhanie A, Tigistu H, Abraham Y, Getachew Y, Khan TM, et al. Prevalence of potential drug–drug interactions among internal medicine ward in University of Gondar Teaching Hospital, Ethiopia. Asian Pacific Journal of Tropical Biomedicine. 2014;4:S204-S8.
46. Biase TMMA, Silva MT, Galvao TF. Potential drug interactions in adults living in the Brazilian Amazon: A population-based case-control study, 2019. Exploratory research in clinical and social pharmacy. 2021;3:100056.
47. Bačar Bole C, Nagode K, Pišlar M, Mrhar A, Grabnar I, Vovk T. Potential drug-drug interactions among patients with schizophrenia spectrum disorders: prevalence, association with risk factors, and replicate analysis in 2021. Medicina. 2023;59(2):284.
2. Rossing P, Caramori ML, Chan JC, Heerspink HJ, Hurst C, Khunti K, et al. KDIGO 2022 clinical practice guideline for diabetes management in chronic kidney disease. Kidney International. 2022;102(5):S1-S127.
3. de Souza W, de Abreu LC, Silva LGd, Bezerra IMP. Incidence of chronic kidney disease hospitalisations and mortality in Espírito Santo between 1996 to 2017. PLoS One. 2019;14(11):e0224889. PLoS One. 2019;14(11):e0224889.
4. Riskesdas LN. Kementerian Kesehatan Republik Indonesia. Badan Penelitian Dan Pengembangan Kesehatan. 2018.
5. Matsushita K, Mahmoodi BK, Woodward M, Emberson JR, Jafar TH, Jee SH, et al. Comparison of risk prediction using the CKD-EPI equation and the MDRD study equation for estimated glomerular filtration rate. Jama. 2012;307(18):1941-51.
6. Jalalonmuhali M, Lim SK, Md Shah MN, Ng KP. MDRD vs. CKD-EPI in comparison to 51Chromium EDTA: a cross sectional study of Malaysian CKD cohort. BMC nephrology. 2017;18(1):1-6.
7. Hunter-Dickson M, Drak D, Anderson M, Shamu T, Chimbetete C, Dahwa R, et al. Comparison of CG, CKD-EPI [AS] and CKD-EPI [ASR] equations to estimate glomerular filtration rate and predict mortality in treatment naïve people living with HIV in Zimbabwe. BMC nephrology. 2023;24(1):1-6.
8. Cahyani AAAE, Prasetya D, Abadi MF, Prihatiningsih D. Gambaran diagnosis pasien pra-hemodialisa di RSUD Wangaya Tahun 2020-2021. Jurnal Ilmiah Hospitality. 2022;11(1):661-6.
9. Pernefri PNI. Konsensus dialisis. Jakarta: Pernefri. 2003. 21–34.
10. Putra IGSS, Islamiah A. Gambaran klinis dan laboratoris penderita penyakit ginjal kronis yang menjalani hemodialisis di RSUD Muara Teweh, Barito Utara, Kalimantan Tengah. Intisari Sains Medis. 2023;14(1):538-42.
11. Indonesia PN. 11th Report of Indonesian renal registry 2018. Jakarta: Perhimpunan Nefrologi Indonesia. 2018;1–46.12.
12. Insani N, Manggau MA, Kasim H. Analisis efektivitas terapi pada pasien anemia gagal ginjal hemodialisis di RSUP Dr. Wahidin Sudirohusodo Makassar. Majalah Farmasi dan Farmakologi. 2018;22(1):13-5.
13. Adusumilli P, Adepu R. Drug related problems: an over view of various classification systems. Asian J Pharm Clin Res. 2014;7(4):7-10.
14. Hepler CD, Strand LM. Opportunities and responsibilities in pharmaceutical care. American journal of hospital pharmacy. 1990;47(3):533-43.
15. Handayani N, Faisal M, Rusli R. Drug interaction studies in patients with kidney failure inpatient at Panglima Sebaya Hospital, Tanah Grogot. Jurnal Sains dan Kesehatan. 2023;5(4):500-6.
16. Tuloli TS, Madania M, Mustapa MA, Tuli EP. Evaluasi penggunaan obat pada pasien gagal ginjal kronik yang menjalani hemodialisis di RSUD Toto Kabila Periode 2017-2018. Parapemikir: Jurnal Ilmiah Farmasi. 2019;8(2):25-32.
17. Lucida H, Trisnawati R, Suardi M. Analisis aspek farmakokinetika klinik pasien gagal ginjal pada IRNA penyakit dalam RSUP Dr. M. Djamil Padang. Jurnal Sains Dan Teknologi Farmasi. 2011;16(2):144-55.
18. Zhao P, Vieira MdL, Grillo JA, Song P, Wu TC, Zheng JH, et al. Evaluation of exposure change of nonrenally eliminated drugs in patients with chronic kidney disease using physiologically based pharmacokinetic modeling and simulation. The Journal of Clinical Pharmacology. 2012;52(S1):91S-108S.
19. Rengga MPE, Kono RB, Beama CA. Analisis interaksi obat penyakit ginjal kronik di RSUD Prof. Dr. WZ Johannes Kupang. MPI (Media Pharmaceutica Indonesiana). 2021;3(3):179-87.
20. Ashley C, Dunleavy A. The renal drug handbook: the ultimate prescribing guide for renal practitioners: CRC Press; 2018.
21. Indonesia PE. Pedoman petunjuk praktis terapi insulin pada pasien diabetes mellitus 2021. Jakarta: PB PERKENI. 2021.
22. Kementrian Kesehatan Republik Indonesia. Pedoman nasional pelayanan kedokteran tata laksana diabetes melitus tipe 2 dewasa. Kementrian Kesehatan Republik Indonesia; 2020.
23. Kementrian Kesehatan Republik Indonesia. Pedoman nasional pelayanan kedokteran tata laksana hipertensi dewasa. Kementrian Kesehatan Republik Indonesia; 2021.
24. Zhao JV, Schooling CM. The role of testosterone in chronic kidney disease and kidney function in men and women: a bi-directional Mendelian randomization study in the UK Biobank. BMC medicine. 2020;18(1):1-10.
25. Denic A, Lieske JC, Chakkera HA, Poggio ED, Alexander MP, Singh P, et al. The substantial loss of nephrons in healthy human kidneys with aging. Journal of the American Society of Nephrology: JASN. 2017;28(1):313-20.
26. Dybiec J, Szlagor M, Młynarska E, Rysz J, Franczyk B. Structural and functional changes in aging kidneys. International Journal of Molecular Sciences. 2022;23(23):15435.
27. Shafiee MA, Chamanian P, Shaker P, Shahideh Y, Broumand B, editors. The impact of hemodialysis frequency and duration on blood pressure management and quality of life in end-stage renal disease patients. Healthcare; 2017;5(3):52.
28. Chauhan R, Mendonca S. Adequacy of twice weekly hemodialysis in end stage renal disease patients at a tertiary care dialysis centre. Indian journal of nephrology. 2015;25(6):329-33.
29. MacRae C, Mercer SW, Guthrie B, Henderson D. Comorbidity in chronic kidney disease: a large cross-sectional study of prevalence in Scottish primary care. British Journal of General Practice. 2021;71(704):e243-e9.30.
30. Garla V, Kanduri S, Yanes-Cardozo L, Lien LF. Management of diabetes mellitus in chronic kidney disease. Minerva Endocrinologica. 2019;44(3):273-87.
31. Hahr AJ, Molitch ME. Management of diabetes mellitus in patients with chronic kidney disease. Clinical diabetes and endocrinology. 2015;1(1):1-9.
32. Betônico CC, Titan SMO, Lira A, Pelaes TS, Correa- Giannella MLC, Nery M, et al. Insulin glargine U100 improved glycemic control and reduced nocturnal hypoglycemia in patients with type 2 diabetes mellitus and chronic kidney disease stages 3 and 4. Clinical therapeutics. 2019;41(10):2008-20. e3.
33. Kalaitzidis RG, Elisaf MS. Treatment of hypertension in chronic kidney disease. Current hypertension reports. 2018;20:1-10.
34. Sinha AD, Agarwal R. Clinical pharmacology of antihypertensive therapy for the treatment of hypertension in CKD. Clinical Journal of the American Society of Nephrology: CJASN. 2019;14(5):757-64.
35. Gregg LP, Richardson P, Herrera MA, Akeroyd J, Jafry S, Gobbel G, et al. Documented adverse drug reactions and discontinuation of angiotensin converting enzyme inhibitors and angiotensin receptor blockers in chronic kidney disease. American Journal of Nephrology. 2023;54(3-4):126-35.
36. Lexicomp. Drug Interactions Analysis: Wolters Kluwer; 2023.
37. Barbieri MA, Rottura M, Cicala G, Mandraffino R, Marino S, Irrera N, et al. Chronic kidney disease management in general practice: a focus on inappropriate drugs prescriptions. Journal of clinical medicine. 2020;9(5):1346.
38. Sharma R, Chhabra M, Vidyasagar K, Rashid M, Fialova D, Bhagavathula AS. Potentially inappropriate medication use in older hospitalized patients with type 2 diabetes: a Cross-sectional study. Pharmacy. 2020;8(4):219.
39. Youssef A, Almubarak A, Aljohnai M, Alnuaimi M, Alshehri B, Al-ghamdi G, et al. Contraindicated medications administered to inpatients with renal insufficiency in a Saudi Arabian hospital that has a computerized clinical decision support system. Journal of Taibah University Medical Sciences. 2015;10(3):320-6.
40. Fukuba N, Nishida M, Hayashi M, Furukawa N, Ishitobi H, Nagaoka M, et al. The relationship between polypharmacy and hospital-stay duration: a retrospective study. Cureus. 2020; 12(3): e726741.
41. Zeleke TK, Birhan TY, Abdela OA. Medicine dose adjustment practice and associated factors among renally impaired patients in Amhara Regional State, Ethiopia. International Journal of Nephrology. 2021;2021:1-9.
42. Saleem A, Masood I. Pattern and predictors of medication dosing errors in chronic kidney disease patients in Pakistan: a single center retrospective analysis. PLoS One. 2016;11(7):e0158677.
43. Dagnew EM, Ergena AE, Wondm SA, Sendekie AK. Potential drug-drug interactions and associated factors among admitted patients with psychiatric disorders at selected hospitals in Northwest Ethiopia. BMC Pharmacology and Toxicology. 2022;23(1):88.
44. Marquito AB, Fernandes NMdS, Colugnati FAB, Paula RBd. Identifying potential drug interactions in chronic kidney disease patients. Brazilian Journal of Nephrology. 2014;36:26-34.
45. Bhagavathula AS, Berhanie A, Tigistu H, Abraham Y, Getachew Y, Khan TM, et al. Prevalence of potential drug–drug interactions among internal medicine ward in University of Gondar Teaching Hospital, Ethiopia. Asian Pacific Journal of Tropical Biomedicine. 2014;4:S204-S8.
46. Biase TMMA, Silva MT, Galvao TF. Potential drug interactions in adults living in the Brazilian Amazon: A population-based case-control study, 2019. Exploratory research in clinical and social pharmacy. 2021;3:100056.
47. Bačar Bole C, Nagode K, Pišlar M, Mrhar A, Grabnar I, Vovk T. Potential drug-drug interactions among patients with schizophrenia spectrum disorders: prevalence, association with risk factors, and replicate analysis in 2021. Medicina. 2023;59(2):284.
Published
2023-10-25
How to Cite
MARIA, Nisa; SUSILO, Ferlina Vidyananda; SIMARMATA, Mayannaria.
Drug Selection, Dosage Adjustment, and Potential Interaction of Antihypertensive and Antidiabetic for Chronic Kidney Disease with Hemodialysis.
JURNAL ILMU KEFARMASIAN INDONESIA, [S.l.], v. 21, n. 2, p. 254-265, oct. 2023.
ISSN 2614-6495.
Available at: <http://jifi.farmasi.univpancasila.ac.id/index.php/jifi/article/view/1484>. Date accessed: 27 apr. 2024.
doi: https://doi.org/10.35814/jifi.v21i2.1484.
Issue
Section
Articles
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Licencing
All articles in Jurnal Ilmu Kefarmasian Indonesia are an open-access article, distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License which permits unrestricted non-commercial used, distribution and reproduction in any medium.
This licence applies to Author(s) and Public Reader means that the users mays :
- SHARE:
copy and redistribute the article in any medium or format - ADAPT:
remix, transform, and build upon the article (eg.: to produce a new research work and, possibly, a new publication) - ALIKE:
If you remix, transform, or build upon the article, you must distribute your contributions under the same license as the original. - NO ADDITIONAL RESTRICTIONS:
You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.
It does however mean that when you use it you must:
- ATTRIBUTION: You must give appropriate credit to both the Author(s) and the journal, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.
You may not:
- NONCOMMERCIAL: You may not use the article for commercial purposes.
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Tools
