Evaluation of the adequacy of drug prescriptions in patients with chronic kidney disease: results from the CKD‐REIN cohort

Laville, Solène M; Metzger, Marie; Stengel, Bénédicte; Jacquelinet, Christian; Combe, Christian; Fouque, Denis; Laville, Maurice; Frimat, Luc; Ayav, Carole; Speyer, Élodie; Robinson, Bruce M.; Massy, Ziad A.; Liabeuf, Sophie

doi:10.1111/bcp.13738

Cited by 81 publications

(139 citation statements)

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“…We appreciate the interest shown by Professor LK Stamp et al in our article concerning the appropriateness of drug prescriptions in patients with chronic kidney disease (CKD) from the prospective CKD‐REIN cohort (Chronic Kidney Disease‐Renal Epidemiology and Information Network) …”

mentioning

confidence: 99%

Reply to “Restricting maintenance allopurinol dose according to kidney function in patients with gout is inappropriate!” by Stamp et al.

Laville

Stengel

Massy

et al. 2019

Brit J Clinical Pharma

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mentioning

confidence: 99%

Reply to “Restricting maintenance allopurinol dose according to kidney function in patients with gout is inappropriate!” by Stamp et al.

Laville

Stengel

Massy

et al. 2019

Brit J Clinical Pharma

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“…[7] Nevertheless, reported rates of GFR-inappropriate prescriptions (according to the Summary of Product Characteristics -SPCs) range between 9 and 81% for people with CKD. [1], [2] Prescribing for people with CKD is further complicated by comorbid illness. CKD is both a cause and consequence of comorbidity, most notably microvascular, macrovascular and cardiac disease.…”

Section: Ckd-speci C Psismentioning

confidence: 99%

“…Unsurprisingly, this can lead to the prescription of numerous drugs. [1], [10] The prevalence of polypharmacy -de ned as the regular use of ve or more medications per day -was almost 80% in a cohort of over 5000 German people with CKD. [11] Indeed, for older people with advanced CKD, the prevalence of polypharmacy is even higher (91%) and hyperpolypharmacy -de ned as 10 or more medications -is common (43%).…”

Section: Ckd-speci C Psismentioning

confidence: 99%

“…[12] Polypharmacy increases the likelihood of inappropriate prescriptions and is associated with hospitalisation and death in people with CKD. [1], [13] Clinical support systems such as computerised alerts, manual-review and eGFR-prompts have been used to reduce inappropriate prescribing in CKD populations, and can be effective in both inpatient and outpatient settings. [2] Nevertheless, these may over-estimate prescribing errors, especially of drugs for which the bene t/risk ratio may remain high even in the setting of very low GFR -for example those acting on the renin-angiotensin axis.…”

Section: Ckd-speci C Psismentioning

confidence: 99%

“…However, CKD-speci c PSIs relating to a wide range of agents were found and the frequency of PSIs relating to particular agents should not necessarily be seen as indicative of the clinical importance of individual agents, and may simply re ect the frequency with which these agents are used, and/or general familiarity with their CKD-speci c risks. [1] This library of CKD-speci c PSIs is a rst step towards generation of prescribing safety assessments and interventions for populations with CKD.…”

Section: Ckd-speci C Psismentioning

confidence: 99%

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A Systematically Collated Library of Prescribing Safety Indicators for People With Chronic Kidney Disease

Smith

Hayward

Hole

et al. 2020

Preprint

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BackgroundPeople with chronic kidney disease (CKD) have high levels of co-morbidity and polypharmacy placing them at increased risk of prescribing-related harm. Tools for assessing prescribing safety in the general population using prescribing safety indicators (PSIs) have been established. However, people with CKD pose different prescribing challenges to people without kidney disease. Therefore, PSIs designed for use in the general population may not include all PSIs relevant to a CKD population. The aim of this study was to systematically collate a library of PSIs relevant to people with CKD. MethodsA systematic literature search identified papers reporting PSIs. CKD-specific PSIs were extracted and categorised by Anatomical Therapeutic Chemical (ATC) classification codes. Duplicate PSIs were removed to create a final list of CKD-specific PSIs. Results 9,852 papers were identified by the systematic literature search, of which 511 proceeded to full text screening and 196 papers were identified as reporting PSIs. Following categorisation by ATC code and duplicate removal, 841 unique PSIs formed the final set of CKD-specific PSIs. The five ATC drug classes containing the largest proportion of CKD-specific PSIs were: Cardiovascular system (26%); Nervous system (13.4%); Blood and blood forming organs (12.4%); Alimentary and metabolism (12%); and Anti-infectives for systemic use (11.3%).Conclusion CKD-specific PSIs could be used alone or alongside general PSIs to assess the safety and quality of prescribing within a CKD population.

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Potentially inappropriate medications prescribing to elderly patients with advanced chronic kidney by using 2019 American Geriatrics Society Beers Criteria

Chahine

2020

Health Science Reports

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Background and aimsA potentially inappropriate medication (PIM) is defined as a drug‐carrying risks outweighing the expected clinical benefits. Elderly patients with chronic kidney disease (CKD) are particularly at higher risk of drug‐related toxicities. In Lebanon, no studies have been conducted regarding the prescribing of PIMs in hospitalized CKD patients. This study aimed to check the prevalence of PIMs using the American Geriatrics Society (AGS) Beers criteria in elderly patients with advanced CKD stages including dialysis and to identify possible risk factors that may be associated with prescribing PIMs in this population.MethodsA retrospective cross‐sectional study was conducted on patients with advanced CKD above the age of 65 years and admitted between January 2019 and June 2019 to two University Hospitals in Beirut, Lebanon. We used multiple logistic regression analysis to determine which factors were associated with prescription of PIMs according to AGS Beers criteria‐2019.ResultsThe study sample included 199 patients with renal dysfunction, 75.9% were aged 70 years or more, 53.8% were females, and 61.8% were prescribed five drugs or more. Eighty‐two patients were receiving hemodialysis (41.2%). PIMs prevalence was 34.1% (68/199 patients) according to Beers criteria in elderly patients with advanced CKD stages.The most frequently prescribed PIMs were ranitidine (39.1%), enoxaparin (25%), tramadol (9.8%), and ciprofloxacin (5.4%). Polypharmacy (OR 2.1, CI 95% 1.58‐2.79), a higher number of comorbidities (OR 3.01, CI 95% 1.43‐6.30), and coronary artery diseases (OR 3.14 CI 95% 1.44‐6.85) were the factors associated with an increased risk of at least one PIM prescription.ConclusionOur study found that one out of three patients with advanced CKD had at least one PIM according to the latest Beers criteria. A large proportion of inappropriate prescribing is preventable by increasing awareness of prescribing physicians to the explicit lists of PIMs.

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Evaluation of the adequacy of drug prescriptions in patients with chronic kidney disease: results from the CKD‐REIN cohort

Abstract: Our results emphasize the complexity of drug management for CKD patients, for whom inappropriate prescription appears to be common.

Cited by 81 publications

References 29 publications

Reply to “Restricting maintenance allopurinol dose according to kidney function in patients with gout is inappropriate!” by Stamp et al.

Reply to “Restricting maintenance allopurinol dose according to kidney function in patients with gout is inappropriate!” by Stamp et al.

A Systematically Collated Library of Prescribing Safety Indicators for People With Chronic Kidney Disease

Potentially inappropriate medications prescribing to elderly patients with advanced chronic kidney by using 2019 American Geriatrics Society Beers Criteria

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