Patient-Reported and Actionable Safety Events in CKD

Abstract

Patients with CKD are at high risk for adverse safety events because of the complexity of their care and impaired renal function. Using data from our observational study of predialysis patients with CKD enrolled in the Safe Kidney Care study, we estimated the baseline frequency of adverse safety events and determined to what extent these events co-occur. We examined patient-reported adverse safety incidents (class I) and actionable safety findings (class II), conditioned on participant use of drugs that might cause such an event, and we used association analysis as a data-mining technique to identify co-occurrences of these events. Of 267 participants, 185 (69.3%) had at least one class I or II event, 102 (38.2%) had more than one event, and 48 (18.0%) had at least one event from both classes. The adjusted conditional rates of class I and class II events ranged from 2.9 to 57.6 per 100 patients and from 2.2 to 8.3 per 100 patients, respectively. The most common conditional class I and II events were patient-reported hypoglycemia and hyperkalemia (serum potassium.5.5 mEq/L), respectively. Reporting of hypoglycemia (in patients with diabetes) and falling or severe dizziness (in patients without diabetes) were most frequently paired with other adverse safety events. We conclude that adverse safety events are common and varied in CKD, with frequent association between disparate events. Further work is needed to define the CKD "safety phenotype" and identify patients at highest risk for adverse safety events.

Remote Usability Testing and Satisfaction with a Mobile Health Medication Inquiry System in CKD

“…Individuals with CKD, often characterized by low disease awareness, limited health literacy, and frequent interactions with the health care system (17,18), are at high risk of adverse safety events related to their care, such as drug-related problems. This opens potential to introduce tailored digital tools to this population as patient-initiated safeguards (7,(19)(20)(21)(22). Mobile technologies, such as cellular telephones, provide instant access to information that previously was not promptly available to patients.…”

“…gov NCT 01407367) is an ongoing observational cohort of individuals with predialysis CKD intended to assess the frequency of adverse safety events with a protocol that has been previously described (7). To be eligible for the SKC Study, participants required two measures of renal function with an eGFR of ,60 ml/min per 1.73 m 2 at least 90 days apart and #18 months before enrollment.…”

Chronic Pain and Analgesic Use in CKD

“…At the SKC visit, demographics, medical history, selfreported safety events, and physical measurements were obtained and serum creatinine, potassium, glucose, and venous hemoglobin were collected as previously described (25). The Short Physical Performance Battery test was administered to measure physical function (26).…”

Maintaining Safety in the Dialysis Facility

“…Patients often report errors that were not otherwise detected (78). Patient-reported safety events are actionable (79). Patients are critical partners in establishing an institutional culture of safety (80).…”