Assessment of Appropriate Prescribing in Maintenance Haemodialysis and Comparison of Prescribing Patterns Between State-and Privately-Funded Patients - Retrospective Review

Q: What was the aim of this study on haemodialysis prescribing?

To assess the appropriateness of medication therapy among end stage renal disease patients undergoing haemodialysis at two dialysis centres in Windhoek, and to compare prescribing patterns between state-funded and privately funded patients.

Q: How did the study evaluate medication appropriateness and renal dosage adjustment?

It classified medicines using the Anatomical Therapeutic Chemical (ATC) system and used the Drug Prescribing in Renal Failure Handbook as the primary reference for renal dosage adjustment. Medication choice was checked against KDIGO Clinical Practice Guidelines.

Q: What were the main results regarding inappropriate prescribing?

Out of 147 reviewed patient records, about one-third (33.3%) had at least one or more inappropriately selected medicines. Most patients (82.0%, n=121) had at least one or more inappropriately renally adjusted medicines.

Q: What prescribing differences were observed between state-funded and privately funded patients?

More privately funded patients were prescribed vitamin D or its analogues, phosphate binders, antithrombotic agents, lipid modifying agents, and angiotensin receptor blockers, each with statistically significant differences reported in the study.

Sep 29, 2026

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Assessing medication appropriateness for end stage renal disease patients receiving maintenance haemodialysis, this retrospective review analyzed clinical records from two dialysis centres in Windhoek, Namibia. The study classified prescribed medicines using ATC standards and evaluated renal dosage adjustment with the Drug Prescribing in Renal Failure Handbook, alongside KDIGO guidance for medication choice. Among 147 patients, about one-third had at least one inappropriately selected medicine, and 82% had renally inappropriate adjustments, with notable differences by funding source.

LanguageEnglish

CategoryResearch & Report

FormatPDF

Pages10

Reading Time25 min

AccessFree to download

Background

Aim

Methods

Results

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Keywords

Introduction

Assessment of Appropriate Prescribing in Maintenance Haemodialysis and Comparison of Prescribing Patterns Between State-and Privately-Funded Patients: A Retrospective Review Martha Kampanza 1, Roger Karel Verbeeck 1, Lauren Jonkman 1, and Mwangana Mubita 1 Abstract Hospital Pharmacy 1–10 © The Author(s) 2026 Article reuse guidelines: [sagepub.com/journals-permissions](sagepub.com/journals-permissions)[ ](sagepub.com/journals-permissions)[DOI: 10.1177/00185787251403015](DOI: 10.1177/00185787251403015)[ ](DOI: 10.1177/00185787251403015)[journals.sagepub.com/home/hpx](journals.sagepub.com/home/hpx) Background: Patients with end stage renal disease undergoing haemodialysis commonly have multimorbidity, which in turn leads to polypharmacy. Additionally, end stage renal disease limits the choice and dosage of medicines. In Namibia, patients can access care at privately run dialysis centres. Patients seen at state-run health facilities in need of renal care from the dialysis centres, have their renal care costs covered by the Ministry of Health and Social Services. Aim: The main purpose of this study was to assess the appropriateness of medication therapy among patients with end stage renal disease who underwent haemodialysis at two dialysis centres in Windhoek. Further, the study also compared prescribing patterns between state-funded and privately funded haemodialysis patients. Methods: A retrospective, quantitative and analytic design involving the review of clinical records of patients attending haemodialysis at the two dialysis centres. The types of medicines prescribed were classified according to the Anatomical Therapeutic Chemical (ATC) classification. The Drug Prescribing in Renal Failure Handbook was used as a primary reference for assessing the appropriateness of renal dosage adjustment. The primary references used to check for the appropriateness of medication choice were the KDIGO Clinical Practice Guidelines. Other references were used as secondary sources. Results: A total of 147 patients’ clinical records were reviewed and included in this study. About one-third (33.3%) of patients had at least one or more inappropriately selected medicines. Most patients 82.0%(n = 121) had at least one or more inappropriately renally adjusted medicines. More privately funded patients were prescribed Vitamin D or its analogues (P < .001), phosphate binders (P < .001), antithrombotic agents (P < .001), lipid modifying agents (P < .001), and angiotensin receptor blockers (P < .001). Conclusion: As anticipated, patients on haemodialysis were being managed with a relatively large number of medicines. Renal dosage adjustment could be improved to ensure patient safety. The differences in the prescribing of vital medicines such as phosphate binders, between state funded versus privately funded patients warrants further investigation. Keywords haemodialysis, renal dosage adjustment, medication selection, prescribing patterns, Namibia Introduction The number of people receiving dialysis globally is expected to increase to up to 10 million by the year 2030, with 70% of these individuals living in sub-Saharan Africa. 1,2 In many parts of the world, diabetes mellitus is the leading cause of end stage renal disease (ESRD); however, especially in lowand middle-income countries (LMICs), hypertension, systemic lupus erythematosus, and human immunodeficiency virus (HIV) infection contribute significantly.3 The burden of chronic kidney disease (CKD) is also expected to increase significantly in Namibia due to the continued increasing prevalence of CKD risk factors such as hypertension, 1 University of Namibia, Windhoek, Namibia Corresponding Author: Martha Kampanza, Department of Pharmacy Practice and Policy, Faculty of Health Sciences and Veterinary Medicine, University of Namibia, Bach Street, Windhoek 9000, Namibia. Email: mkampanza@unam.na diabetes mellitus and HIV. For instance, in 2019, 52% of adults aged 3

FAQs

What was the aim of this study on haemodialysis prescribing?

To assess the appropriateness of medication therapy among end stage renal disease patients undergoing haemodialysis at two dialysis centres in Windhoek, and to compare prescribing patterns between state-funded and privately funded patients.

How did the study evaluate medication appropriateness and renal dosage adjustment?

It classified medicines using the Anatomical Therapeutic Chemical (ATC) system and used the Drug Prescribing in Renal Failure Handbook as the primary reference for renal dosage adjustment. Medication choice was checked against KDIGO Clinical Practice Guidelines.

What were the main results regarding inappropriate prescribing?

Out of 147 reviewed patient records, about one-third (33.3%) had at least one or more inappropriately selected medicines. Most patients (82.0%, n=121) had at least one or more inappropriately renally adjusted medicines.

What prescribing differences were observed between state-funded and privately funded patients?

More privately funded patients were prescribed vitamin D or its analogues, phosphate binders, antithrombotic agents, lipid modifying agents, and angiotensin receptor blockers, each with statistically significant differences reported in the study.

Sep 29, 2026

Upload by SANS