Clinical efficacy of Drug Therapy used in Acute Renal Failure Patients

Purpose: To monitor the medication pattern and to assess the clinical outcomes related to antibiotic, antihypertensive and diuretic drug therapy in acute renal failure patients.

Methods: An observational, single centric study of patients with acute renal failure was carried out at Upasana Kidney Hospital, Mehsana. Patients were enrolled as per predetermined criteria. Medical records were reviewed for generic name, dose, dosage form, route of administration prescribed to 105 inpatients related to antibiotic, antihypertensive and diuretic therapy. Clinical outcomes were documented using dialysis record, laboratory parameters. 

Results: Among 105 patients the mean age was 49.69 ± 16.21years (mean ± SD), 71(67.62%) were male and 34 (32.38%) were female. Nearly¹/₅^th of the patients required supportive therapy (diuresis and hemodialysis). Baseline total leucocyte count was 10521 ± 4429 (mean ± SD) per cmm and 3 days since the start of antibiotics was 9106 ± 4898 (mean ± SD) per cmm(p<0.05). SBP and DBP at baseline were 141.25±22.12 (mean ± SD) mmHg and 86.80 ± 12.11 (mean ± SD) mmHg(p=0.24) and 24 hours after the antihypertensive treatment were 138.58 ± 19.36 (mean ± SD) mmHg and 84.51 ± 8.57 (mean ± SD) mmHg(p<0.05) respectively. Urine output at baseline was 580.00 ± 351.83 (mean ± SD) ml and 3 days since the start of diuretics was 927.500 ± 352.98 (mean ± SD) ml(p<0.05).Serum creatinine(p=0.13) and potassium level(p=0.60) did not change significantly after start of diuretic therapy compared to baseline values.

Conclusion: Appropriate and early initiation of antibiotic therapy in infective illness is suggested to improve the outcome in acute renal failure. Incrementing antibiotics in combinations of mono and double antibiotic therapy were effective in decreasing the infection significantly while increasing mean duration of hospital stay. The differences observed between various antihypertensive and diuretic therapy combinations have not been effective in reducing blood pressure significantly.