Nephrotoxic drug burden and predictors of exposure among patients with renal impairment in Ethiopia: A multi-center study

Tirsit Ketsela Zeleke; Leila Kenzu Kemal; Eden Abetu Mehari; Faisel Dula Sema; Abdulwase Mohammed Seid; Gizework Alemnew Mekonnen; Rahel Belete Abebe

doi:10.1016/j.heliyon.2024.e24618

Nephrotoxic drug burden and predictors of exposure among patients with renal impairment in Ethiopia: A multi-center study

Heliyon. 2024 Jan 12;10(2):e24618. doi: 10.1016/j.heliyon.2024.e24618. eCollection 2024 Jan 30.

Authors

Tirsit Ketsela Zeleke¹, Leila Kenzu Kemal², Eden Abetu Mehari², Faisel Dula Sema², Abdulwase Mohammed Seid², Gizework Alemnew Mekonnen², Rahel Belete Abebe²

Affiliations

¹ Department of Pharmacy, College of Medicine and Health Sciences, Debre Markos University, Debre Markos, Ethiopia.
² Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.

Abstract

Background: Nephrotoxic drugs may hasten the decline in kidney function and worsen the progression of renal impairment as a result; these drugs should be avoided or used with caution in patients with pre-existing renal insufficiency. The purpose of this study was to assess the burden of nephrotoxic medication use and its predictors among patients with underlying renal impairment.

Methods: A multicenter, institution-based, cross-sectional study was conducted from May 30, 2021 to July 30, 2021, at medical wards. Renal impaired patients admitted during the data collection period who took at least one medication were enrolled in the study. A simple random sampling technique was used to select the study participants. Data was collected through an interview and a medical card review. Both bivariable and multivariable binary logistic regression analyses were fitted to identify factors associated with nephrotoxic drug use.

Results: Among the 422 participants, more than half of them (53.6 %) were male. The mean patient's age was 47.5 (±16.7) years. A total of 1310 drugs were prescribed for 422 patients with renal impairment, of which 80.15 % were nephrotoxic. Nephrotoxic drugs were prescribed for 66.4 % of patients. The burden of nephrotoxic medication prescription was significantly associated with variables like the presence of comorbidity (AOR = 6.31, 95 % CI: 2.01-19.79), the number of medications prescribed (AOR = 1.43, 95 % CI: 1.05-1.93), and the age of participants (AOR = 1.12, 95 % CI: 1.07-1.17).

Conclusion: The present study demonstrated that two-third of the patients with renal impairment were exposed to nephrotoxic medications. Furosemide, Enalapril, and vancomycin were the most frequently prescribed nephrotoxic medications. The study suggests that prescribers need to give special attention to older patients who have underlying renal insufficiency, a comorbid condition, and polypharmacy regarding exposure to contraindicated nephrotoxic medication.

Keywords: Ethiopia; Nephrotoxic medication prescription; Renal impairment.