title: Prescribing pattern of medicines in chronic kidney disease with emphasis on phosphate binders.
abstract: OBJECTIVE
  Patients with chronic kidney disease (CKD) suffer with multiple comorbidities and complications like secondary hyperparathyroidism and hyperphosphotemia. Altered mineral metabolism contributes to bone disease and cardiovascular disease. In patients of CKD, despite dietary phosphorus restriction, phosphate binders (PBs) are recommended to control phosphorous level. No studies about the utilization pattern of PBs in CKD patients have been reported from India. This study analyses the current prescribing trends in the management of CKD patients undergoing tertiary care with focus on PBs.
  
  
  METHODS
  This cross-sectional, observational study was conducted in nephrology department of a government super speciality hospital over 8-month period from January to August 2011. Demographic, clinical, and medication details were collected in a specially designed proforma.
  
  
  RESULTS
  A total 111 prescriptions were included in the study. Average number of drugs per prescription was 9.47. About 41.53% of the prescribed drugs were from the World Health Organization essential medicines list. Out of total prescribed drugs (1052), most commonly prescribed were vitamins and minerals (24.71%), cardiovascular drugs, (22.14%), and hematopoietic agents (20.15%). Considering individual drugs, five most commonly prescribed drugs were multivitamins (14.82%), iron (8.65%), folic acid (8.55%), calcium carbonate (8.17%), and calcitriol (5.60%). A total of 11.02% of prescribed drug were PBs. Among PBs, calcium carbonate was the most frequently prescribed and sevelamer was the least prescribed PB. No patient was prescribed lanthanum carbonate.
  
  
  CONCLUSIONS
  This study identified a wide variety of drug classes including PBs prescribed in CKD patients. Although sevelamer hydrochloride has less side effects as compared to calcium salts, it was less prescribed since it is costlier.
authors.affiliation: Department of Pharmacology, Government Medical College, Nagpur, Maharashtra, India.
authors.forename: Chaitali S
authors.initials: CS
authors.lastname: Bajait
authors.affiliation: Department of Pharmacology, Government Medical College, Nagpur, Maharashtra, India.
authors.forename: Sonali A
authors.initials: SA
authors.lastname: Pimpalkhute
authors.affiliation: Department of Pharmacology, Government Medical College, Nagpur, Maharashtra, India.
authors.forename: Smita D
authors.initials: SD
authors.lastname: Sontakke
authors.affiliation: Department of Pharmacology, Government Medical College, Nagpur, Maharashtra, India.
authors.forename: Kavita M
authors.initials: KM
authors.lastname: Jaiswal
authors.affiliation: Department of Pharmacology, Government Medical College, Nagpur, Maharashtra, India.
authors.forename: Amruta V
authors.initials: AV
authors.lastname: Dawri
mesh_terms: D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D011307:Drug Prescriptions; D017723:Drug Utilization Review; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D011446:Prospective Studies
keywords: Calcium acetate; calcium carbonate; drug utilization study; lanthanum carbonate; sevelamer hydrochloride