Assessment of Appropriate Prescribing in Maintenance Haemodialysis and Comparison of Prescribing Patterns Between State- and Privately-Funded Patients: A Retrospective Review

Background: Patients with end stage renal disease undergoing haemodialysis commonly have multimorbidity, which in turn leads to polypharmacy. Additionally, end stage renal disease limits the choice and dosage of medicines. In Namibia, patients can access care at privately run dialysis centres. Patients seen at state-run health facilities in need of renal care from the dialysis centres, have their renal care costs covered by the Ministry of Health and Social Services. Aim: The main purpose of this study was to assess the appropriateness of medication therapy among patients with end stage renal disease who underwent haemodialysis at two dialysis centres in Windhoek. Further, the study also compared prescribing patterns between state-funded and privately funded haemodialysis patients. Methods: A retrospective, quantitative and analytic design involving the review of clinical records of patients attending haemodialysis at the two dialysis centres. The types of medicines prescribed were classified according to the Anatomical Therapeutic Chemical (ATC) classification. The Drug Prescribing in Renal Failure Handbook was used as a primary reference for assessing the appropriateness of renal dosage adjustment. The primary references used to check for the appropriateness of medication choice were the KDIGO Clinical Practice Guidelines . Other references were used as secondary sources. Results: A total of 147 patients’ clinical records were reviewed and included in this study. About one-third (33.3%) of patients had at least one or more inappropriately selected medicines. Most patients 82.0% (n = 121) had at least one or more inappropriately renally adjusted medicines. More privately funded patients were prescribed Vitamin D or its analogues ( P < .001), phosphate binders ( P < .001), antithrombotic agents ( P < .001), lipid modifying agents ( P < .001), and angiotensin receptor blockers ( P < .001). Conclusion: As anticipated, patients on haemodialysis were being managed with a relatively large number of medicines. Renal dosage adjustment could be improved to ensure patient safety. The differences in the prescribing of vital medicines such as phosphate binders, between state funded versus privately funded patients warrants further investigation.