Analiza faktora koji utiču na racionalno propisivanje lekova kod pacijenata sa bubrežnom insuficijencijom

Abstract

Introduction. Prescribing may be inappropriate if the potential benefits outweigh risks, when there are more appropriate alternatives for prescribed drugs or when potentially useful drug was omitted. PIP in elderly is quite widespread, but it is preventable, given that valid explicit criteria for determining improper prescribing of drugs are used in practice, such as Beers, STOPP and START criteria.

Purpose. The main objective of this study is to determine the prevalence of PIP on the sample of elderly patients with different degrees of kidney failure and to explore factors that influence rational prescribing of drugs. We used Beers, STOPP and START criteria to identify potentially inadequately prescribed drugs.

Methods. The research was performed at the Department of Nephrology, Clinical Center Niš. The data were collected from medical files and patient surveys. The study included a total of 218 patients aged 65 years and over, of which 83 patients (38.1%) were undergoing chronic hemodialysis treatment due to the end stage kidney failure (the first group), while the other 135 patients (61.9% ), with varying degrees of renal insufficiency, was examined in the daily hospital of the Clinic for Nephrology (the second group).

Results. The number of patients with potentially inadequately prescribed medication, or medications, did not differ significantly between patients with CKF treated with hemodialysis and those examined in the daily hospital. The main predictors of PIP in our patients were a greater number of co-morbidity and polypharmacy. The patients living in the urban places, the patients with lower levels of education, as well as the patients who did not read the drug instructions, had significantly greater number of PIP’s. Conclusion. Оur study showed that potentially inappropriate prescribing of drugs was frequent phenomenon in both hemodialysis patients and those without renal replacement therapy, present in about a third of patients from both groups. Determining factors that may be associated with the PIP can be of great help in clinical practice in the complex decision-making process.