Prescribing patterns and health-related quality of life in patients with chronic kidney disease: a cross-sectional study

Abstract

Background: Chronic kidney disease (CKD) is associated with multimorbidity, polypharmacy, and impaired health-related quality of life (HRQoL). This study evaluated prescribing patterns using World Health Organization (WHO) core prescribing indicators and HRQoL using the RAND 36-item health survey 1.0 among patients with CKD. Methods: A cross-sectional observational study was conducted among 162 adults with CKD in India. Prescribing patterns were assessed using WHO core prescribing indicators, and HRQoL was evaluated using the RAND-36 questionnaire. Associations between prescribing burden, patient characteristics, and physical component summary (PCS) and mental component summary (MCS) scores were analysed. Results: The mean number of drugs per encounter was 12.77±3.68. Generic prescribing (38.64%) and essential medicines list (EML) adherence (61.57%) were below WHO benchmarks, while injection prescribing (29.23%) exceeded recommendations. Cardiovascular agents were the most frequently prescribed drug class (34.26%). HRQoL was impaired across all domains (PCS: 30.23±6.57; MCS: 35.30±5.30). Advancing CKD stage was associated with lower PCS and MCS (both p<0.001). Older age was associated with lower PCS (p<0.001), whereas higher medication burden was associated with lower MCS (p=0.034). Medication burden was also associated with greater comorbidity burden (p=0.007) and longer hospitalisation (p<0.001). Conclusions: Patients with CKD experienced substantial polypharmacy, suboptimal adherence to WHO prescribing indicators, and impaired HRQoL. These findings highlight the need for rational prescribing, medication review, and routine patient-reported outcome assessment.