A focus on CKD reporting and inappropriate prescribing among older patients discharged from geriatric and nephrology units throughout Italy: A nationwide multicenter retrospective cross-sectional study

Abstract

Older hospitalized patients with chronic kidney disease (CKD) are part of the geriatric population with a substantial risk of potentially inappropriate medication (PIM) use. The high rates of multimorbidity and polypharmacy, along with the progressive decline of eGFR, contribute to increasing the risk of drug–drug and drug–disease interactions, overdosing, and adverse drug reactions (ADRs). In this multicenter cross-sectional study, we aimed to evaluate the prevalence of CKD under-reporting and PIMs among older patients discharged from acute geriatric and nephrology units throughout Italy. Renal function was determined by estimated glomerular filtration rate (eGFR) through the Berlin Initiative Study (BIS) equation; the prevalence of PIMs was calculated by revising drug prescriptions at discharge according to STOPP criteria, Beers criteria, and summaries of product characteristics (smPCs). A descriptive analysis was performed to compare the clinical and pharmacological characteristics of patients in the two distinct settings; univariate and multivariate logistic regression models were performed to explore factors associated with CKD under-reporting in the discharge report forms and PIM prevalence. Overall, the study population consisted of 2,057 patients, aged 83 (77–89) years, more commonly women, with a median of seven (5–10) drugs prescribed at discharge. CKD under-reporting was present in 50.8% of the study population, with higher rates in geriatric vs. nephrology units (71.1% vs. 10.2%, p < 0.001). 18.5% of the study population was discharged with at least one renally inappropriate medication; factors associated with at least one contraindicated drug at discharge were the number of drugs (PR 1.09, 95% CI 1.14–1.19); atrial fibrillation (PR 1.35, 95% CI 1.01–1.81); diabetes (PR 1.61, 95% CI 1.21–2.13); being hospitalized in nephrology units (PR 1.62, 95% CI 1.14–2.31), CKD stage 3b (PR 2.35, 95% CI 1.34–4.13), and stage 4–5 (PR 14.01, 95% CI 7.36–26.72). Conversely, CKD under-reporting was not associated with the outcome. In summary, CKD under-reporting and inappropriate medication use were common in older patients discharged from hospital; the relatively high number of PIMs in both nephrology and geriatric settings underlines the need to improve appropriate prescribing during hospital stay and to decrease the risk of ADRs and side effects in this highly vulnerable population.

Potentially inappropriate medication prescribing based on 2019 Beers criteria and the impact of pharmacist intervention in elderly patients with kidney diseases: A report from Iran

“…Our results are consistent with some studies that reported PPIs and benzodiazepines as the most prevalent PIM classes. 14,27,32 Additionally, our results are consistent with the results of a previously published study by Díez et al, which reported that PPIs and benzodiazepines were the most prescribed PIMs in elderly residents in a nursing home. 33 According to the literature, long-term PPI administration (for more than 8 weeks) can result in some adverse effects, including an increased risk of gastrointestinal infection, such as Clostridium difficile infection.…”

“…Pantoprazole and alprazolam were touched the highest proportion of prescribed PIMs. Our results are consistent with some studies that reported PPIs and benzodiazepines as the most prevalent PIM classes 14,27,32 . Additionally, our results are consistent with the results of a previously published study by Díez et al, which reported that PPIs and benzodiazepines were the most prescribed PIMs in elderly residents in a nursing home 33 …”

Appropriateness of direct oral anticoagulant prescribing in older subjects with atrial fibrillation discharged from acute medical wards

“…Data was sourced from the Italian Society of Nephrology‐Italian Society of Gerontology and Geriatrics (SIN‐SIGG) study, an observational, retrospective, cross‐sectional study cooperatively funded by the Italian Society of Nephrology and the Italian Society of Gerontology and Geriatrics 13 . The study aimed at collecting information about chronic kidney disease (CKD) reporting and medication prescribing/dosing in patients aged ≥65 years consecutively discharged from 24 geriatric and 15 nephrology units in Italy within the first half of 2018.…”

Associations between potentially inappropriate prescribing and increased number of medications with postdischarge health outcomes among geriatric rehabilitation inpatients: RESORT study

“…The mean age was 82.6 years, and 56.3% were female. Approximately, 72% of patients used a walking aid and the median frailty and CCI scores were 6 [5][6][7] and 2 [1][2][3][4], respectively. The primary reasons for hospital admissions were musculoskeletal disorders (47%), followed by neurological disorders (15%).…”

“…4 Increased medication use is, in turn, linked to potentially inappropriate prescribing (PIP). 5,6 The burden of polypharmacy, along with age-related decline in renal function, increases the risk of inappropriate prescription of renally excreted medications, 7 contributing to heightened risk of medication-related harm.…”