Knowledge, attitude and perceptions of pharmacists regarding renal dose adjustment among chronic kidney disease patients in Pakistan

Zafar et al. Journal of Pharmaceutical Policy and Practice https://doi.org/10.1186/s40545-023-00606-4 (2023) 16:102 Journal of Pharmaceutical Policy and Practice Open Access RESEARCH Knowledge, attitude and perceptions of pharmacists regarding renal dose adjustment among chronic kidney disease patients in Pakistan Roheena Zafar1,2*, Inayat Ur Rehman1*, Yasar Shah1, Zahid Ali3, Long Chiau Ming4 and Tahir Mehmood Khan5 Abstract Background Chronic kidney disease (CKD) poses a significant public health challenge. CKD patients have compromised renal function, which not only alters the pharmacokinetics of drugs but also their pharmacodynamics. Adjusting drug doses for these patients is essential to achieve the intended clinical outcomes, prevent adverse drug events, and halt further progression of the disease. Pharmacists play a pivotal role in ensuring safe and appropriate therapy for CKD patients. However, there is a noticeable absence of national dosing guidelines for CKD in Pakistan, coupled with a scarcity of studies exploring the knowledge, attitude, and perception of renal dose adjustments in the country. This study aimed to evaluate the knowledge, attitudes, and perceptions of pharmacists in the Khyber Pakhtunkhwa province and Islamabad regarding renal dose adjustments. Methodology A cross-sectional study was conducted to gauge the knowledge, attitude, and perception of pharmacists working in various cities of Khyber Pakhtunkhwa and the capital city, Islamabad, from February to May 2023. The Renal Dosing Questionnaire-13 (RDQ-13) scale was employed for this purpose. The survey link was disseminated through emails, and the RDQ-13 scale was also completed in person by pharmacists from hospitals, clinics, community, and retail settings who interact with CKD patients. Univariate linear regression was employed, and factors with a p value < 0.25 were subjected to multivariate linear regression. For comparing knowledge, attitude, and perception scores of pharmacists, the independent t test and one-way ANOVA were utilized as appropriate. A p value < 0.05 was deemed statistically significant. Results Of the 384 pharmacists approached, 270 completed the RDQ-13 scale, resulting in a response rate of 70.3%. The overall knowledge score regarding renal dose adjustment was 21.24 ± 2.18 (mean ± SD). Attitude scores averaged at 10.04 ± 1.81, and perception scores at 7.19 ± 2.15. Multivariate analysis indicated a positive correlation between the pharmacists’ perception scores and gender, with male pharmacists scoring higher than their female counterparts. *Correspondence: Roheena Zafar Inayat Ur Rehman Full list of author information is available at the end of the article © The Author(s) 2023. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Zafar et al. Journal of Pharmaceutical Policy and Practice (2023) 16:102 Page 2 of 11 Conclusions The study underscores the importance of instituting targeted training programs for pharmacists, ensuring access to dependable resources, and promoting research and results dissemination in the realm of renal pharmacotherapy to enhance public health outcomes. Keywords Knowledge, Attitude, Perception, Renal dose adjustment, RDQ-13, Pakistan Background Chronic kidney disease (CKD) is emerging as a significant public health issue in Pakistan, with an estimated prevalence affecting 12.5–31.2% of the population [1]. A 2018 systematic review reported a 23.3% CKD prevalence in the country [2]. The disease is notably prevalent among the elderly, women, and those with comorbidities, especially hypertension and diabetes. This prevalence often results in polypharmacy, subsequently raising the potential for drug-related complications [3]. While hypertension and diabetes mellitus are established as primary drivers of CKD [4, 5], a recent Pakistani study noted associations between diabetes and hypertensive nephropathy in 27.1% and 15.2% of patients, respectively [6]. Moreover, approximately 43.6% of individuals over 50 years in Pakistan are diagnosed with CKD [7], though literature presents varied findings regarding the gender most affected by CKD [2]. In CKD, diminished renal function impacts both the pharmacokinetics and pharmacodynamics of various drugs [8, 9]. Consequently, dose adjustments are essential to attain the desired clinical outcomes, mitigate adverse drug events, and prevent disease progression [10]. Yet, even with available dosing adjustment guidelines, 25–77% of CKD patients experience inappropriate dose adjustments [11, 12]. Specifically, in Pakistan, a 2023 study found that 56.1% of medications requiring dose modifications were not aptly adjusted for CKD patients [13]. Pharmacists, integral to multidisciplinary healthcare teams, are pivotal in addressing drug-related concerns, given their clinical training. They excel in ensuring patient safety through activities, such as screening, dispensing, inspecting, counseling, and offering inpatient pharmaceutical services [14]. Multiple studies highlight the positive influence of pharmacists in managing CKD and end-stage renal disease, thereby enhancing outcomes and refining patient care [14–16]. A Japanese study observed that a lower proportion of community pharmacists (54.2%) implemented renal dosage adjustments in their daily routines compared to their hospital counterparts (91.5%) [17]. Yet, another multicenter study suggested that community pharmacists, when granted access to clinical data, appropriate training, and support from hospital-based peers with specialized knowledge, can elevate the quality of patient care [18]. Given the pivotal role pharmacists play in ensuring the safety and appropriateness of therapy for CKD patients, and considering the absence of national dosing guidelines for CKD in Pakistan, coupled with limited studies assessing knowledge, attitudes, and perceptions about renal dose adjustments, it is imperative to evaluate these attributes among pharmacists in various he (...truncated)