Drug Dosage Adjustment Practice and Associated Factors Among Patients with Renal Impairment Admitted to The Medical Ward at Jigjiga Public Hospitals, Somali Region, Ethiopia: A Mixed Method Study

Background Kidney disease impacts the way medications are eliminated from the body, therefore dosage adjustment needs to be considered when prescribing a medication for renal impaired patient to avoid toxicity and accumulation. The aim of this study was to determine drug dosage adjustment practice and associated factors among renal impaired patient admitted Jigjiga Public Hospitals Objectives To assess drug dosage adjustment practice and associated factors among patients with renal impairment admitted to the medical wards at Jigjiga Public Hospitals, Somali region, Ethiopia, from April 1 to May 20, 2024. Methods and materials: An institutional-based Convergent mixed method study was carried out among all renal impaired patients admitted to Jigjiga Public hospitals from April 1 to May 20, 2024. The quantitative data were collected using kobo toolbox and exported STATA Version 17 for analysis. Bivariable and multivariable binary logistic regression was performed. Finally, the adjusted odds ratio with a 95% confidence level was computed, and a p-value < 0.05 was used to declare statistical significance. The qualitative data was transcribed, coded, categorized, and key themes were formed through a thematic approach using Dedoose software. Lastly, results were triangulated using a continuous narrative approach. Results Inappropriate drug dosage adjustment of this study was 58% (95%CI:51.7, 63.8). Hospital stay ≥ 7 days (AOR = 3.06; 95% CI: 1.03, 6.08), Prescribed drugs ≥ 5 (AOR = 3.35; 95% CI: 1.15, 7.72), stage V Chronic kidney disease (AOR = 0.08; 95% CI: 0.02, 0.14). Presence of comorbidities (AOR = 8.73; 95% CI: 2.40, 11.7), and Prescribers experience (≥ 5 years) (AOR = 0.15; 95% CI: 0.04, 0.56) were predictors of inappropriate dose adjustment. Patient overload, prescribers’ knowledge, underestimation of renal function & adverse events of drugs, lack of standardized guideline, poor staff integration, presence of comorbidities and laboratory error were predictors to inappropriate dose adjustment as unveiled by the qualitative study. Conclusions The study revealed that inappropriate dosage adjustment in patients with renal impairment was considerably high. Training for health care providers, use of standard guidelines and assessment of renal function should be encouraged for good dosage adjustment practice.