Comparative analysis of potential drug-drug interactions in a public and private hospital among chronic kidney disease patients in Khyber Pakhtunkhwa: A retrospective cross-sectional study

PLOS ONE RESEARCH ARTICLE Comparative analysis of potential drug-drug interactions in a public and private hospital among chronic kidney disease patients in Khyber Pakhtunkhwa: A retrospective crosssectional study a1111111111 a1111111111 a1111111111 a1111111111 a1111111111 Roheena Zafar1,2, Inayat Ur Rehman ID1*, Yasar Shah1, Long Chiau Ming3, Hui Poh Goh4*, Khang Wen Goh5 1 Department of Pharmacy, Garden Campus, Abdul Wali Khan University Mardan, Mardan, Pakistan, 2 Department of Pharmacy, North West General Hospital and Research Center, Hayatabad Peshawar, Pakistan, 3 School of Medical and Life Sciences, Sunway University, Bandar Sunway, Malaysia, 4 PAPRSB Institute of Health Sciences, Universiti Brunei Darussalam, Bandar Seri Begawan, Brunei Darussalam, 5 Faculty of Data Science and Information Technology, INTI International University, Nilai, Malaysia * (IUR); (HPG) OPEN ACCESS Citation: Zafar R, Rehman IU, Shah Y, Ming LC, Goh HP, Goh KW (2023) Comparative analysis of potential drug-drug interactions in a public and private hospital among chronic kidney disease patients in Khyber Pakhtunkhwa: A retrospective cross-sectional study. PLoS ONE 18(9): e0291417. https://doi.org/10.1371/journal.pone.0291417 Editor: Muhammad Junaid Farrukh, UCSI University, MALAYSIA Received: May 8, 2023 Accepted: August 29, 2023 Abstract Introduction Chronic kidney disease (CKD) is a significant public health challenge due to its rising incidence, mortality, and morbidity. Patients with kidney diseases often suffer from various comorbid conditions, making them susceptible to potential drug-drug interactions (pDDIs) due to polypharmacy and multiple prescribers. Inappropriate prescriptions for CKD patients and their consequences in the form of pDDIs are a major challenge in Pakistan. Published: September 29, 2023 Peer Review History: PLOS recognizes the benefits of transparency in the peer review process; therefore, we enable the publication of all of the content of peer review and author responses alongside final, published articles. The editorial history of this article is available here: https://doi.org/10.1371/journal.pone.0291417 Copyright: © 2023 Zafar et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability Statement: All relevant data are within the paper. Public access to all raw data is restricted due to the consent from that participants Aim This study aimed to compare the incidence and associated risk factors of pDDIs among a public and private sector hospital in Khyber Pakhtunkhwa, Pakistan. Method A retrospective cross-sectional study design was conducted to compare pDDIs among public and private sector hospitals from January 2023 to February 2023. Patients profile data for the full year starting from January 1 2022 to December 302022, was accessed All adult patients aged 18 years and above, of both genders, who currently have or have previously been diagnosed with end-stage renal disease (ESRD) were included. For assessing pDDIs, patient data was retrieved and checked using Lexicomp UpToDate® for severity and documentation of potential drug-drug interactions. PLOS ONE | https://doi.org/10.1371/journal.pone.0291417 September 29, 2023 1 / 13 PLOS ONE agreed to. All data related queries can be addressed by Dr. Inayat Ur Rehman (inayat.rehman@awkum. edu.pk); and Mr. Shah Faisal (). Funding: The authors received no specific funding for this work. Competing interests: The authors have declared that no competing interests exist. Comparison of drug-drug interactions in a public and private hospitals among CKD patients Results A total of 358 patients’ data was retrieved (with n = 179 in each hospital); however, due to incomplete data, n = 4 patients were excluded from the final analysis. The prevalence of pDDIs was found to be significantly higher in private hospitals (84.7%) than in public hospitals (26.6%), with a p-value <0.001. Patients in the age category of 41–60 years (AOR = 6.2; p = 0.008) and those prescribed a higher number of drugs (AOR = 1.2; p = 0.027) were independently associated with pDDIs in private hospitals, while the higher number of prescribed drugs (AOR = 2.9; p = <0.001) was an independent risk factor for pDDIs in public hospitals. The majority of pDDIs (79.0%) were of moderate severity, and a significant number of patients (15.1%) also experienced major pDDIs, with a p-value <0.001. The majority of pDDIs had fair documentation for reliability rating in both public and private hospitals. Conclusion The prevalence of pDDIs was higher among CKD patients at private hospitals, and most of the pDDIs were of moderate severity. A considerable number of patients also experienced major pDDIs. The risk of experiencing pDDIs was found to be higher in older patients and among those prescribed a higher number of drugs. Introduction Chronic kidney disease (CKD), due to its increased cases and morbidity and mortality, is considered a challenging global health problem [1, 2]. According to the 2019 study of the Global Burden of Disease (GBD), approximately 697 million CKD cases were reported worldwide [2]. In 2019, CKD was ranked as the eleventh leading cause of mortality and morbidity globally, resulting in 1.43 million deaths. Given the rise in CKD cases and mortality, it is expected that the number of cases will reach 4.0 million by 2040 [3, 4]. Furthermore, CKD patients experience worse clinical outcomes and compromised quality of life [5–8]. These patients with CKD often suffer from complications [9–11], i.e. diabetes mellitus [10, 12], cardiovascular disease (CVD) [13, 14] and hypertension [15, 16]; therefore, polypharmacy is inevitable and highly prevalent among these patients. The use of multiple medications for managing comorbidities further exacerbates the progression of CKD [10]. Polypharmacy in CKD is associated with increased healthcare costs, poor medication adherence, and significantly contributes to drug-related problems, including adverse drug reactions and drug-drug interactions (DDIs) [17, 18]. The consequences of DDIs can be life-threatening and may even lead to lethal toxicities [15]. Additionally, the pharmacokinetic and pharmacodynamic profiles of the majority of drugs excreted by the kidneys are altered as a result of CKD itself, which can contribute to the occurrence of DDIs [19]. DDIs result in an augmented risk of morbidity and mortality among CKD patients, diminished quality of life, and also prolonged hospitalization [20]. The estimated incidence of potential DDIs (pDDIs) varies from 3–5% among patients consuming fewer medicines, while among those who receive 10–20 medications, the chances increase to 20% [15]. The potential risks for pDDIs in CKD patients include increased patient age and an increase in the number of drugs [21]. (...truncated)