Factors associated with the frequency of antihypertensive drug adjustments in chronic kidney disease patients: a multicentre, 2-year retrospective study

• Main Authors: Bavanandan, S. (Author), Islahudin, F. (Author), Lee, F.Y (Author), Makmor-Bakry, M. (Author), Wong, H.-S (Author)
• Format: Article
• Language: English
• Published: Springer Science and Business Media Deutschland GmbH 2021
• Subjects: acute kidney failure; Adjustments; adult; Adult; aged; albuminuria; alpha adrenergic receptor blocking agent; alternative medicine; amiloride; analgesic agent; angiotensin receptor antagonist; antianemic agent; antidiabetic agent; antigout agent; antihypertensive agent; Antihypertensive Agents; Antihypertensive drugs; antihypertensive therapy; antithrombocytic agent; Article; beta adrenergic receptor blocking agent; bradycardia; calcium channel blocking agent; cardiovascular agent; Chronic Kidney Disease; chronic kidney failure; clinical trial; cohort analysis; controlled study; coughing; dipeptidyl carboxypeptidase inhibitor; diuretic agent; dizziness; drug dose reduction; drug hypersensitivity; drug substitution; drug withdrawal; end stage renal disease; estimated glomerular filtration rate; female; follow up; foot edema; gastrointestinal agent; headache; heart palpitation; human; Humans; hyperkalemia; hypertension; Hypertension; hypotension; immunosuppressive agent; impaired glucose tolerance; insulin derivative; kidney function; lipid; lipid fingerprinting; major clinical study; Malaysia; male; Medication Adherence; medication compliance; methyldopa; minoxidil; multicenter study; nonsteroid antiinflammatory agent; patient compliance; Renal Insufficiency, Chronic; renal replacement therapy; Retrospective Studies; retrospective study; side effect; spironolactone; tertiary care center; thorax pain; uric acid
• Online Access: View Fulltext in Publisher
• ISBN: 22107703 (ISSN)
• DOI: 10.1007/s11096-021-01252-z

Background Optimum antihypertensive drug effect in chronic kidney disease is important to mitigate disease progression. As frequent adjustments to antihypertensive drugs might lead to problems that may affect their effectiveness, the modifiable factors leading to frequent adjustments of antihypertensive drugs should be identified and addressed. Objective This study aims to identify the factors associated with frequent adjustments to antihypertensive drugs among chronic kidney disease patients receiving routine nephrology care. Setting Nephrology clinics at two Malaysian tertiary hospitals. Method This multi-centre, retrospective cohort study included adult patients under chronic kidney disease clinic follow-up. Demographic data, clinical information, laboratory data and medication characteristics from 2018 to 2020 were collected. Multiple logistic regression was used to identify the factors associated with frequent adjustments to antihypertensive drugs (≥ 1 per year). Main outcome measure Frequent adjustments to antihypertensive drugs. Results From 671 patients included in the study, 219 (32.6%) had frequent adjustments to antihypertensive drugs. Frequent adjustment to antihypertensive drugs was more likely to occur with follow-ups in multiple institutions (adjusted Odds Ratio [aOR] 1.244, 95% confidence interval [CI] 1.012, 1.530), use of traditional/complementary medicine (aOR 2.058, 95% CI 1.058, 4.001), poor medication adherence (aOR 1.563, 95% CI 1.037, 2.357), change in estimated glomerular filtration rate (aOR 0.970, 95% CI 0.951, 0.990), and albuminuria categories A2 (aOR 2.173, 95% CI 1.311, 3.603) and A3 (aOR 2.117, 95% CI 1.349, 3.322), after controlling for confounding factors. Conclusion This work highlights the importance of close monitoring of patients requiring initial adjustments to antihypertensive drugs. Antihypertensive drug adjustments may indicate events that could contribute to poorer outcomes in the future. © 2021, The Author(s), under exclusive licence to Springer Nature Switzerland AG.