Factors Affecting Antihypertensive Adverse Drug Reaction among Chronic Kidney Disease Patients

Abstract

ABSTRACT Context: Chronic kidney disease (CKD) patients are frequently prescribed antihypertensives to slow the progression of the disease through the reduction of proteinuria and controlled blood pressure (BP). Antihypertensives often cause adverse drug reactions (ADRs) such as hyperkalemia, dry cough, and dizziness, to name a few. However, there is a lack of work in determining clinical and genetic factors associated with ADR among CKD patients. Aims: This work aimed to determine the clinical and genetic factors associated with ADR among CKD patients. Settings and Design: A prospective observational cohort study was performed in tertiary hospitals. Subjects and Methods: CKD patients >18 years, on at least one antihypertensive, with a follow-up for 1 year were included. Blood samples were collected for the identification of CYP2C19*2, CYP2D6*10, and CYP3A5*3. Statistical Analysis Used: A simple and multiple logistic regression was performed to determine factors associated with ADR. Results: A total of 188 patients were included. The most common antihypertensive used was renin–angiotensin–aldosterone system inhibitors (n = 148, 78.7%), which were found to cause most of the ADR (n = 15, 48.4%). Factors associated with ADR were female (adjusted odds ratio [AOR] =0.29, 95% confidence interval [CI] = 0.09–0.96; P = 0.04), nonsmokers (AOR = 0.19, 95% CI = 0.04–0.91, P = 0.04), and systolic BP (SBP) >138 mmHg (AOR = 0.19, 95% CI = 0.06–0.58, P < 0.01). An ADR was 3.4, 5.1, and 5.4 times more likely to occur among males, nonsmokers, and an SBP <138 mmHg, respectively (χ 2[13] = 28.9, P = 0.007). Conclusions: Closer monitoring of ADR should be performed among CKD hypertensive patients to ensure optimized management. Further work on demographic, clinical, and genetic polymorphisms should be performed in future studies regarding antihypertensive ADR.