Chronic Kidney Disease Management in General Practice: A Focus on Inappropriate Drugs Prescriptions

Rottura, Michelangelo; Cicala, Giuseppe; Mandraffino, R.; Marino, Sebastiano; Irrera, Natasha; Mannucci, Carmen; Santoro, Domenico; Squadrito, Francesco; Arcoraci, Vincenzo

doi:10.3390/jcm9051346

Cited by 21 publications

(29 citation statements)

References 37 publications

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“…The recorded diagnosis of CKD did not modify the percentage of patients treated with at least one contraindicated drug at discharge, as previously noted (Barbieri et al, 2020). Specifically, the increase in the number of different drugs taken and the severity of CKD were the factors associated with an increased risk of inappropriateness.…”

Section: Discussionsupporting

confidence: 70%

“…This is the first study evaluating factors associated with contraindicated drug use in older adults with CKD in internal medicine and geriatric wards. To the best of our knowledge, few studies concerning inappropriate drug prescription in patients followed by other specialists or by general practitioners are available (Barbieri et al, 2020;Chahine, 2020;Roux-Marson et al, 2020;Troncoso-Mariño et al, 2021). In this context, older patients with eGFR <60 ml/min/1.73 m 2 were mainly women: the CKD mostly affects females due to gender differences in renal pathophysiology (Cobo et al, 2016;Carrero et al, 2018).…”

Section: Discussionmentioning

confidence: 99%

“…The burden of CKD arouses the interest from the healthcare system for a more careful appraisal of the GFR values into the management of drug prescriptions. A recent Italian retrospective population-based study in a general practice setting showed that 56.8% of CKD affected patients received inappropriate prescriptions with a significantly greater probability when treated with more drugs, with more comorbidities and during the end stages of CKD (Barbieri et al, 2020). Nevertheless, the management of older patients with GFR <60 ml/min/1.73 m 2 in the hospital setting is a little-discussed issue in recent literature (Tesfaye et al, 2019;Roux-Marson et al, 2020;Troncoso-Mariño et al, 2021).…”

Section: Introductionmentioning

confidence: 99%

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Kidney Disease Management in the Hospital Setting: A Focus on Inappropriate Drug Prescriptions in Older Patients

et al. 2021

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Aging with multimorbidity and polytherapy are the most significant factors that could led to inappropriate prescribing of contraindicated medications in patients with chronic kidney disease (CKD). The aim of this study was to evaluate the prescriptions of contraindicated drugs in older adults in CKD and to identify their associated factors in a hospital context. An observational retrospective study was carried out considering all patients ≥65 years with at least one serum creatinine value recorded into the REPOSI register into 2010–2016 period. The estimated glomerular filtration rate (eGFR) was applied to identify CKD. A descriptive analysis was performed to compare demographic and clinical characteristics; logistic regression models were used to estimate factors of inappropriate and percentage changes of drug use during hospitalization. A total of 4,713 hospitalized patients were recorded, of which 49.8% had an eGFR <60 ml/min/1.73 m2; the 21.9% were in treatment with at least one inappropriate drug at the time of hospital admission with a decrease of 3.0% at discharge (p = 0.010). The probability of using at least one contraindicated drug was significantly higher in patients treated with more several drugs (OR 1.21, 95% CI 1.16–1.25, p <0.001) and with CKD end-stages (G4: 16.90, 11.38–25.12, p < 0.001; G5: 19.38, 11.51–32.64, p < 0.001). Low-dose acetylsalicylic acid was the contraindicated drug mainly used at the time of admission, reducing 1.2% at discharge. An overall increase in therapeutic appropriateness in hospitalized older patients with CKD was observed, despite a small percentage of therapeutic inappropriateness at discharge that underlines the need for a closer collaboration with the pharmacologist to improve the drug management.

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Section: Discussionsupporting

confidence: 70%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Kidney Disease Management in the Hospital Setting: A Focus on Inappropriate Drug Prescriptions in Older Patients

et al. 2021

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“…Among patients prescribed NSAIDs, approximately 10% of these patients had moderately or severely impaired kidney function (eGFR <60 mL/min/1.73 m 2 ). Use of NSAIDs can lead to a worsening of renal function, 26 and use of opioids without dose reduction can result in drug accumulation and consequently ADRs 27 . Although we did not stratify analgesic use on dose, caution is warranted concerning use of NSAIDs and opioids among patients with impaired kidney function who undergo THA or TKA.…”

Section: Discussionmentioning

confidence: 96%

Drug‐related challenges following primary total hip and knee arthroplasty

Sørensen

Nyeland

Odgaard

et al. 2021

Basic Clin Pharma Tox

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We aimed to characterize the in‐hospital analgesic use among total hip or knee arthroplasty (THA or TKA) patients, and to identify possible drug‐related challenges. We identified 15 263 patients operated with a THA or TKA between 1 January 2012 and 30 April 2016. The prevalence of analgesic users and patients with potential clinically relevant drug‐drug interactions (DDIs), along with the prevalence of readmission among patients with vs. without a DDI, were calculated. A DDI was defined as the combination of (A) a diuretic, an angiotensin‐converting enzyme inhibitor or an angiotensin II receptor blocker, and an non‐steroidal anti‐inflammatory Drug (NSAID); (B) warfarin and an NSAID; and (C) a benzodiazepine or a benzodiazepine‐related drug and an opioid. The prevalence of analgesics administered in THA and TKA patients was 99.3% and 99.1% for paracetamol and 93.8% and 98.8% for opioids, respectively. The prevalence of patients who received interaction A, B or C was 8.4%, 2.5% and 40.7%, respectively. Patients with vs. without a DDI had a higher prevalence of 30‐day readmission. In conclusion, most THA and TKA patients were administered paracetamol or opioids. The prevalence of 30‐day readmission was higher in patients with than in patients without a potential clinically relevant DDI.

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“…Nonsteroidal anti‐inflammatory drugs (NSAIDs) are among the most commonly prescribed drugs in the world, including over the counter availability 1,2 . This is due to their wide range of action as agents with anti‐inflammatory and analgesic properties.…”

Section: Introductionmentioning

confidence: 99%

Kidney damage from nonsteroidal anti‐inflammatory drugs—Myth or truth? Review of selected literature

Drożdżal

Lechowicz

Szostak

et al. 2021

Pharmacology Res & Perspec

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Chronic Kidney Disease Management in General Practice: A Focus on Inappropriate Drugs Prescriptions

Cited by 21 publications

References 37 publications

Kidney Disease Management in the Hospital Setting: A Focus on Inappropriate Drug Prescriptions in Older Patients

Kidney Disease Management in the Hospital Setting: A Focus on Inappropriate Drug Prescriptions in Older Patients

Drug‐related challenges following primary total hip and knee arthroplasty

Kidney damage from nonsteroidal anti‐inflammatory drugs—Myth or truth? Review of selected literature

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