Abstract

CHALLENGES AND PATTERNS OF DRUG UTILISATION IN CHRONIC KIDNEY DISEASE: A REVIEW OF APPROPRIATENESS, SAFETY AND ADHERENCE

Surya S. Nair*, Dr. Nithin Manohar R., Dr. Padmesh P. R., Dr. Prasobh G. R., Farhana N. and Safna Faisal

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Abstract

Chronic kidney disease (CKD) is a progressive condition requiring careful medication management due to altered pharmacokinetics, polypharmacy, and increased adverse drug event (ADE) risks. Patients often have multiple comorbidities necessitating complex drug regimens, making appropriate, safe, and adherent medication use essential. This review highlights key challenges in CKD drug utilisation, focusing on dosing adjustments, ADE prevention, and adherence. Antihypertensives, erythropoiesis-stimulating agents, phosphate binders, and diuretics require monitoring to prevent toxicity or therapeutic failure. Nephrotoxic drugs like NSAIDs, aminoglycosides, and contrast agents further complicate therapy. Inappropriate prescribing, drug interactions, and drug-disease interactions necessitate regular medication reviews and therapeutic monitoring. Adherence remains a major issue due to the high pill burden, complex dosing, side effects, and psychosocial barriers. Poor adherence accelerates disease progression and increases hospitalizations. Strategies like patient education, simplified regimens, digital reminders, and pharmacist-led interventions can enhance adherence. Pharmacists play a key role in medication reconciliation, patient counselling, and therapeutic monitoring, improving treatment safety and efficacy. A multidisciplinary approach integrating evidence-based prescribing, renal-specific dose adjustments, ADE prevention, and adherence support is vital for optimal CKD management.

Keywords: Chronic kidney disease (CKD), Medication adherence, Adverse drug events (ADEs), Renal dose adjustment, Nephrotoxicity.