Evaluation of Drug Utilization Patterns Using WHO Indicators in Patients with End-Stage Chronic Kidney Disease: A Cross-Sectional Study in Kirkuk, Iraq

Abstract

Background: Chronic kidney disease (CKD) is a challenging problem. Drug use evaluation is an important issue for the recommended medications. Objective: To assess drug utilization patterns among end-stage CKD patients in Kirkuk, Iraq, based on World Health Organization (WHO) prescribing indicators. Methods: A cross-sectional study was conducted in Kirkuk, Iraq, involving data collection from Al-Amal Centre for Dialysis. A hospital-based convenience sampling technique was used to recruit a total of 314 patients diagnosed with end-stage CKD (stage 5) from October 2025 to January 2026. Results: Most patients were less than 60 years of age (59.24%), with a mean age of 57.1 years, and a male predominance (60.51%). The mean number of comorbidities per patient was 2.9. The encountered comorbidities in CKD patients were hypertension (89%), anemia (88%), and diabetes mellitus (41%). The average number of drugs per prescription was 13, and antibiotics were 42.35%. About 79.96% of drugs prescribed are generics, and injectables represent 82.48%, while the percentage of drugs prescribed according to the essential drug list is 48.76%. Conclusions: There is a critical prevalence of polypharmacy and a dependence on non-essential medications, which significantly increases the risk of severe drug responses and financial burdens for patients with chronic kidney disease. The high incidence of generic prescriptions is a positive step toward lowering costs, but it is overshadowed by the overuse of injectables and antibiotics, as well as the excessive number of medications per prescription.