THE IMPACT OF ANTIHYPERTENSIVE DRUG THERAPY IN PATIENTS WITH CHRONIC KIDNEY DISEASE: A PROSPECTIVE OBSERVATIONAL COHORT STUDY

  • ALMAS SAFINA KAUSER PharmD, Department of Pharmacy Practice, MESCO College of Pharmacy, Hyderabad, Telangana, India
  • HABEEB UNNISA PharmD, Department of Pharmacy Practice, MESCO College of Pharmacy, Hyderabad, Telangana, India
  • AFIFA NAMREEN PharmD, Department of Pharmacy Practice, MESCO College of Pharmacy, Hyderabad, Telangana, India
  • AYESHA SABA PharmD, Department of Pharmacy Practice, MESCO College of Pharmacy, Hyderabad, Telangana, India
  • JAVED AKHTAR ANSARI Professor, Department of Pharmacy Practice, MESCO College of Pharmacy, Hyderabad, Telangana, India

Abstract

Objective: Hypertension (HTN) is both a cause and an effect of chronic kidney disease (CKD). To adequately control blood pressure (BP) in CKD, choosing antihypertensive strategies with the highest nephro-protective effect is crucial for preventing or reversing end-stage renal disease (ESRD) progression and reducing cardiovascular disease (CVD) risk. The present study was therefore designed to evaluate the impact of clinical use of antihypertensive drug therapy in patients with CKD and ESRD.


Methods: It is a prospective observational cohort study. The patients were divided into two cohorts i.e.; non-dialysis dependent (NDD) and dialysis-dependent (DD) CKD. This study was conducted for six months in the Nephrology department, Osmania General Hospital, Hyderabad, India. The data collected and entered into Microsoft Excel (2007) and mean, SD and range were calculated using SPSS version 25.


Results: Antihypertensive drugs were prescribed alone or in combination based on the co-morbidities associated with CKD and HTN. Loop diuretics (Furosemide and Torsemide) and calcium channel blocker (Amlodipine, Nifedipine and Cilnidipine) were most commonly prescribed antihypertensive drugs. Triple therapy (44.11%) was prescribed mostly in both the cohorts (NDD = 16.66%+DD = 27.45%) of which calcium channel blockers+loop diuretic+sympatholytic accounts for 19.16% (NDD = 5.88%+DD = 13.73%). 


Conclusion: The practice of prescribing antihypertensive drugs for the management of HTN and to achieve BP targets in CKD and ESRD remains uncertain. The development of new and revised guidelines is needed to reduce inappropriate variations in practice and promote better delivery of evidence-based treatment.

Keywords: Chronic Kidney Disease (CKD), Non-Dialysis Dependent (NDD), Dialysis Dependent (DD), National Kidney Foundation Kidney Disease Outcomes Quality Initiative (NKF KDOQI), Kidney Disease: Improving Global Outcomes (KDIGO), Joint National Committee (JNC)

Downloads

Download data is not yet available.

References

1. Varughese S, Abraham G. Chronic kidney disease in India. Clin J Am Soc Nephrol 2018;13:802-4.
2. Levin A, Stevens PE, Bilous RW, Coresh J, De Francisco ALM, de Jong PE, et al. Kidney disease: improving global outcomes (KDIGO) CKD workgroup. KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int 2013;3 Suppl 1:1–150.
3. Centers for Disease Control and Prevention. National chronic kidney disease fact sheet: general information and national estimates on chronic kidney disease in the United States, 2010. Atlanta, GA: U. S. Department of Health and Human Services, CDC; 2010.
4. Elsayed AS, Azab AE. Correlation between chronic kidney diseases and hematological data in sabratha hospital in libya. Asian J Pharm Clin Res 2017;10:291-6.
5. Dipiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM. editors. Textbook of pharmacotherapy-a pathophysiological approach. Chapter 44: Chronic kidney disease. 10th ed. New York: McGraw Hill; 2017. p. 1944-2015.
6. Singh AK, Farag YM, Mittal BV, Subramanian KK, Acharya VN, Keithireddy SR, et al. Epidemiology and risk factors of chronic kidney disease in India–results from the SEEK (Screening and Early Evaluation of Kidney Disease) study. BMC Nephrol 2013;14:114.
7. GBD 2015 Disease and Injury Incidence and Prevalence, Collaborators. (8 October 2016). Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990–2015: a systematic analysis for the global burden of disease study. Lancet 2015;388:1545–602.
8. GBD 2015 Mortality and Causes of Death, Collaborators. (8 October 2016). Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980-2015: a systematic analysis for the Global Burden of Disease Study. Lancet 2015;388:1459–544.
9. Tedla FM, Brar A, Browne R, Brown C. Hypertension in chronic kidney disease: navigating the evidence. Int J Hypertens 2011;2011:1-9.
10. Go AS, Chertow GM, Fan D, McCulloch CE, Hsu CY. Chronic kidney disease and the risks of death, cardiovascular events and hospitalization. N Engl J Med 2004;351:1296–305.
11. Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL Jr, et al. Seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure (JNC 7). Hypertens 2003;42:1206-52.
12. Abraham G, Arun KN, Gopalakrishnan N, Renuka S, Pahari DK, Deshpande P, et al. Management of hypertension in chronic kidney disease: consensus statement by an expert panel of Indian nephrologists. J Assoc Physicians India 2017;65 Suppl 2:6-22.
13. Toto RD. Management of hypertensive chronic kidney disease: role of calcium channel blockers. J Clin Hypertens 2005;7(4, Suppl 1):15-20.
14. Ravera M, Re M, Deferrari L, Vettoretti S, Deferrari G. Importance of blood pressure control in chronic kidney disease. J Am Soc Nephrol 2006;17(4, Suppl 2):98–103.
15. Jacobsen P, Rossing K, Tarnow L, Rossing P, Mallet C, Poirier O, et al. Progression of diabetic nephropathy in normotensive type 1 diabetic patients. Kidney Int 1999;56 Suppl 71:101-5.
16. Ritchie J, Rainone F, Green D, Alderson H, Chiu D, Middleton R, et al. Extreme elevations in blood pressure and all-cause mortality in a referred CKD population: results from the CRISIS study. Int J Hypertens 2013:1-8. http://dx.doi.org/ 10.1155/2013/597906.
17. Ptinopoulou AG, Pikilidou MI, Lasaridis AN. The effect of antihypertensive drugs on chronic kidney disease: a comprehensive review. Hypertens Res 2012;36:91-101.
18. ALLHAT Officers and coordinators for the ALLHAT collaborative research group. Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker vs diuretic: The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). JAMA 2002;288:2981–97.
19. National Kidney Foundation K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis 2002;39(2, Suppl 1):1–266.
20. Salvetti A, Mattei P, Sudano I. Renal protection and antihypertensive drugs. Drugs 1999;57:665-93.
21. Gargiulo R, Suhail F, Lerma E. Hypertension and chronic kidney disease. Dis Mon 2015;61:387-95.
22. UK Renal Association eCKD guide; 2011. Available from: http://www.renal.org [Last accessed on 09 Jun 2019].
23. Becker GJ, Wheeler DC, De Zeeuw D, Fujita T, Furth SL, Holdaas H, et al. Kidney disease: improving global outcomes (KDIGO) blood pressure workgroup. KDIGO clinical practice guideline for the management of blood pressure in chronic kidney disease. Kidney Int Suppl 2012;2:337-414.
24. Sinha AD, Agarwal R. Clinical pharmacology of antihypertensive therapy for the treatment of hypertension in CKD. Clin J Am Soc Nephrol 2018;14:757-64.
25. Kidney disease outcomes quality initiative (K/DOQI) clinical practice guidelines on hypertension and antihypertensive agents in chronic kidney disease. Am J Kidney Dis 2004;43(5, Suppl 1):1-290.
26. Kidney disease outcomes quality initiative (K/DOQI) clinical practice guidelines on hypertension and antihypertensive agents in chronic kidney disease: executive summary. Am J Kidney Dis 2004;43(5, Suppl 1):16-41.
27. Varma PV, Chakravarthi MR, Jyothsna G. Hypertension in patients with chronic kidney disease. Hypertens J 2016;2:28-34.
28. Parati G, Ochoa J, Bilo G, Agarwal R, Covic A, Dekker F, et al. Hypertension in chronic kidney disease part 1. Hypertens 2016;67:1093-101.
29. Jesky M, Lambert A, Burden AC, Cockwell P. The impact of chronic kidney disease and cardiovascular comorbidity on mortality in a multi-ethnic population: a retrospective cohort study. Br Med J Open 2013;3:e003458.
30. Ku E, McCulloch C, Vittinghoff E, Lin F, Johansen K. Use of antihypertensive agents and association with risk of adverse outcomes in chronic kidney disease: focus on angiotensin?converting enzyme inhibitors and angiotensin receptor blockers. J Am Heart Assoc 2018;7:e009992.
31. Bakris G, Hart P, Ritz E. Beta-blockers in the management of chronic kidney disease. Kidney Int 2006;70:1905-13.
32. Calcium channel blockers and cardiovascular protection [Internet]. Escardio.org. 2019. Available from: https:// www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/ Volume-6/Calcium-channel-blockers-and-cardiovascular-protection [Last accessed on 09 Jun 2019].
Statistics
184 Views | 29 Downloads
Citatons
How to Cite
KAUSER, A. S., H. UNNISA, A. NAMREEN, A. SABA, and J. A. ANSARI. “THE IMPACT OF ANTIHYPERTENSIVE DRUG THERAPY IN PATIENTS WITH CHRONIC KIDNEY DISEASE: A PROSPECTIVE OBSERVATIONAL COHORT STUDY”. International Journal of Pharmacy and Pharmaceutical Sciences, Vol. 11, no. 12, Dec. 2019, pp. 10-15, doi:10.22159/ijpps.2019v11i12.35659.
Section
Original Article(s)