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Browsing Pharmacy by Author "Bayan Jamal AL-Deen Nammourah"

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    Evaluation of Prescribing Pattern and Compliance to Treatment Guidelines in Hemodialysis Patients in Hebron Governmental Hospital
    (2015) Bayan Jamal AL-Deen Nammourah; Dr. Rowa’ Al-Ramahi
    Background: Chronic kidney disease (CKD) including end-stage renal disease (ESRD) is a growing epidemic. Hemodialysis (HD) is the most commonly used renal replacement therapy in addition to the management of diabetes, hypertension, dyslipidemia, anemia, and bone mineral disorder in hemodialysis patients. Objectives: The objectives of this study were to asses prescribing pattern and to evaluate compliance to treatment guidelines in hemodialysis patients. Method: This study was an observational retrospective cohort study, it was conducted at Hebron governmental hospital / Palestine between March and April 2014. All adult on chronic HD there were included. All information were collected from governmental electronic health record (AviCenna HIS program), and patients were asked to answer some questions when data was not found in the system. Statistical analysis was performed by using Statistical Package for Social Sciences (SPSS) program. Results: During the study period 158 HD patients were prescribed 1567 medication orders of 103 different medications, 49 medications for the management of chronic illness, and 54 medications for acute illness. The patients were taking a minimum of 2 and a maximum of 18 medications, with a mean of 9.92±2.94. The most commonly prescribed medications were calcium carbonate (91.8%), followed by alfacalcidol (84.8%), then iron/folic acid (69.6 %). About (36.7%) of the patients had diabetes, and hemoglobin A1c (HbA1c) test which reflect average blood sugar level for the past 2-3 months was not performed for these patients. Insulin mixtard, insulin actrapid, and glibenclamide were used to control diabetes . A majority of the patients (72.2%) had Hypertension. The target predialysis blood pressure of <140/90 mmHg were achieved in 77.2% of the patients (70.5% of the males vs 87.3% of the females; P- value =0.014) , and post dialysis blood pressure of < 130/80 were achieved 57.6% of the patients. Target predialysis correlate with postdialysis blood pressure ( r=0.236, P- value =0.003) and amlodipine was the most commonly used drug for the management of hypertension which is differ from what the guidelines advise. Atorvastatin was the most prescribe medication for dyslipidemia (39.9%). Patients with total cholesterol levels of < 200 mg/dl were 78.3% patients. Regarding triglycerides levels, 96.2% had levels of < 500 mg/dl. There was an association between the control of the total cholesterol and triglycerides as 80.1% of the patients had total cholesterol of < 200 mg/dl ( P- value =0.006). In the management of anemia, patients who reached goal hemoglobin (Hb) of 11-12 mg/dl according to the national kidney foundation (NKF) guidelines were 8.9% patients only. If kidney disease improving global outcome (KDIGO) guidelines are used, these guidelines accept a Hb level between 9-11.5 mg/dl but not to exceed 13 mg/dl, the patients in this range was 43.0% cases. Transferrin levels were not measured. Iron was used by 69.9% of the patients, and erythropoietin stimulating agents (ESA) by 5.1% of the patients as it was not available in the hospital, and very expensive to purchased by the patient’s own accounts. No data was available for calcium, and parathyroid hormone levels to manage bone mineral disorder, Target phosphorus level was obtained in 12% of the patients according to the NKF guidelines. If serum phosphorus normal range of 2.5–4.5 mg/dl is used according to KDIGO guidelines, this target was achieved in 4.4% patients only. Calcium carbonate was used by 91.8%, sevelamir by 15.8%, and alfacalcidol by 84.8% of the HD patients. Conclusion: The results reflect a poor compliance to treatment guidelines according to NKF and KDIGO guidelines for diabetes, hypertension, dyslipidemia, anemia, and bone mineral disorder. The target levels for treatment are not achieved in many HD patients. The medications are not prescribed optimally to the patients and many investigations and laboratory tests are not performed.