Publication:

Assessment of drug prescribing pattern and quality indicators among chronic kidney disease patients in a tertiary hospital in Northern Ghana

Background Drug utilization research in chronic kidney disease (CKD) patients is essential for identifying prescribing pattern, and evaluating prescribing quality against standard prescribing indicators and clinical guidelines. Evidence from Ghana on this research topic is limited. This study aimed to assess drug prescribing pattern and quality prescribing indicators among CKD patients in a tertiary hospital in Northern Ghana.

Methods Retrospective cross-sectional study was conducted among CKD patients in the Tamale Teaching Hospital.

Results Cardiovascular drugs were the commonly utilized across all CKD stages (n=790,31.7%). Potential appropriate prescribing of antihypertensive agents (93.5%), and renin-angiotensin system (RAS) inhibitors alone (66.1%) were higher compared to combined RAS inhibitor with diuretic (55.4%), phosphate binders (50.0%) and statins (35.6%). Patients with advance CKD stages received fewer RAS inhibitors but more statins compared to stag-3 CKD patients. There was optimal compliance with avoidance of inappropriate prescription including dual RAS inhibitors, erythropoietin stimulating agent (ESA) and digoxin. For contraindicated prescribing, metformin (57.9%) was higher than nonsteroidal anti-inflammatory drugs (NSAIDs) (1.2%) and the combination of NSAIDs + RAS inhibitor + diuretic (1.1%).

Conclusions This study is the first the assessment of prescribing quality indicators among CKD patients in Ghana. It provides findings for clinical practice improvement and establishes baseline evidence for future research. Priority areas for improvement include prescribing RAS inhibitors alone or combined with diuretic, phosphate binders and statins when indicated. However, there is urgent need for intervention to reduce contraindicated prescribing of metformin in the setting.