Adherence to Biochemical Monitoring Recommendations in Patients Starting with Renin Angiotensin System Inhibitors

Bootsma, Janet E. M.; Herwaarden, Margreet F. Warlé-van; Verbeek, A.L.M.; Füssenich, Peter; Smet, Peter A. G. M. De; Rikkert, Marcel Gm Olde; Kramers, Cornelis

doi:10.2165/11587250-000000000-00000

Cited by 17 publications

(14 citation statements)

References 37 publications

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“…The rate found in our study (around 11%) is unsurprisingly low. Low monitoring rates have been found in previous study whether in RASIs initiation (34% of control in the first 3 weeks [8]) or with chronically prescribed ARBs/ACEIs/diuretics (68 to 72% of annual control [14]). Furthermore, in our study the level of DDIs risk is not associated with a greater control.…”

Section: Discussionmentioning

confidence: 66%

“…Furthermore, in our study the level of DDIs risk is not associated with a greater control. In Bootsma et al study [8], being under NSAIDs was not associated to an adequate control either in patients starting ACEI/ARB therapy.…”

Section: Discussionmentioning

confidence: 83%

“…This time frame is pharmacologically relevant and already used in monitoring of initiation or intensification of Renin Angiotensin System Inhibitors (RASIs) [8]. We also explored laboratory monitoring before start of NSAID with monitoring occurring in the year previous first prescription of NSAID.…”

Section: Methodsmentioning

confidence: 99%

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Laboratory Monitoring of Patients Treated with Antihypertensive Drugs and Newly Exposed to Non Steroidal Anti-Inflammatory Drugs: A Cohort Study

et al. 2012

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Background Drug-Drug Interactions between Non Steroidal Anti-Inflammatory Drugs (NSAIDs) and Angiotensin Converting Enzyme Inhibitors (ACEIs), Angiotensin Receptor Blocker (ARBs) or diuretics can lead to renal failure and hyperkalemia. Thus, monitoring of serum creatinine and potassium is recommended when a first dispensing of NSAID occur in patients treated with these drugs. Methods We conducted a pharmacoepidemiological retrospective cohort study using data from the French Health Insurance Reimbursement Database to evaluate the proportion of serum creatinine and potassium laboratory monitoring in patients treated with ACEI, ARB or diuretic and receiving a first dispensing of NSAID. We described the first dispensing of NSAID among 3,500 patients of a 4-year cohort (6,633 patients treated with antihypertensive drugs) and analyzed serum creatinine and potassium laboratory monitoring within the 3 weeks after the first NSAID dispensing. Results General Practitioners were the most frequent prescribers of NSAIDs (85.5%, 95% CI: 84.3–86.6). The more commonly prescribed NSAIDs were ibuprofen (20%), ketoprofen (15%), diclofenac (15%) and piroxicam (12%). Serum creatinine and potassium monitoring was 10.7% (95% CI: 9.5–11.8) in patients treated by ACEIs, ARBs or diuretics. Overall, monitoring was more frequently performed to women aged over 60, treated with digoxin or glucose lowering drugs, but not to patients treated with ACEIs, ARBs or diuretics. Monitoring was more frequent when NSAIDs' prescribers were cardiologists or anesthesiologists. Conclusion Monitoring of serum creatinine and potassium of patients treated with ACEIs, ARBs or diuretics and receiving a first NSAID dispensing is insufficiently performed and needs to be reinforced through specific interventions.

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Section: Discussionmentioning

confidence: 66%

Section: Discussionmentioning

confidence: 83%

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Laboratory Monitoring of Patients Treated with Antihypertensive Drugs and Newly Exposed to Non Steroidal Anti-Inflammatory Drugs: A Cohort Study

et al. 2012

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“…In a Dutch study, serum creatinine monitoring within 3 weeks after initiation of therapy was measured in 34% of patients and in a study from the US 68.4% of patients were monitored for serum creatinine within 1 year. 33,34 The only significant association found was the association between the risk group categories and potassium monitoring ever performed after initiation of therapy. Considering that the study did not find rigorous and consistent biochemical monitoring, this finding was perhaps a chance event.…”

Section: Ras-inhibitorsmentioning

confidence: 97%

“…In high risk patients the frequency of creatinine monitoring was even lower, at 22%. 34 NSAIDS and RAS-inhibitors are also available and frequently used in Ghana. However, there is hardly any literature describing the frequency of their use and whether prescribers take into account risk factors when deciding to perform biochemical monitoring in patients on RAS-inhibitors, and when deciding to co-administer GPAs in patients on NSAIDs.…”

Section: Introductionmentioning

confidence: 99%

Safe use of NSAIDs and RAS-inhibitors at Agogo Presbyterian Hospital, Ghana

Meulendijks¹,

Adomako²,

Appiah³

et al. 2016

Ghana Medical Journal

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SUMMARYBackground: Preventable adverse events of medication are an important cause of hospital admissions in the developed world, in which non-steroidal anti-inflammatory drugs (NSAIDs) and renin-angiotensin system (RAS-) inhibitors are frequently involved. NSAIDs and RAS-inhibitors are also often used in Ghana. The purpose of this study is to assess whether biochemical monitoring in patients on RAS-inhibitors, and co-administration of gastro protective agents (GPAs) in patients on NSAIDs, is done properly in Ghana. Material and methods: Two retrospective cross-sectional studies were carried out at the Agogo Presbyterian Hospital, Ghana, in 2013. In 114 out-and inpatients who are on NSAIDs, the risk for gastrointestinal side effects and the frequency of co-administration of GPAs were determined. In 301 outpatients who are on RAS-inhibitors, the risk for renal dysfunction and the frequency of biochemical monitoring were determined. Fisher's exact test was used to determine the statistical strength. Results: Co-administration of GPAs was done in 1.8% of patients on NSAIDs. Serum creatinine and potassium monitoring within one month after initiation of treatment with RAS-inhibitors were performed in 6.3% and 3.7%, respectively. Risk factors were neither associated with prescription of a GPA in patients on NSAIDs (p=0.134), nor in performing biochemical monitoring in patients on RAS-inhibitors (p=0.219 for creatinine, p=0.062 for potassium). Conclusions: Biochemical monitoring in patients on RAS-inhibitors and use of GPAs in patients on NSAIDs is poorly performed at the Agogo Presbyterian Hospital in Ghana. Improving the already existing Ghanaian guidelines, especially those for RAS-inhibitors, and encouraging their widespread use among prescribers should be pursued.

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Nierinsufficiëntie en medicatie

Esselink

Haan

Kramers

2014

Inzichten in De Nefrologie

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Adherence to Biochemical Monitoring Recommendations in Patients Starting with Renin Angiotensin System Inhibitors

Abstract: We demonstrated that, despite positive intentions of physicians, the biochemical monitoring recommendation in patients treated with RASIs is poorly met. In addition, serum creatinine monitoring was significantly less often performed in high-risk patients compared with low-risk patients.

Cited by 17 publications

References 37 publications

Laboratory Monitoring of Patients Treated with Antihypertensive Drugs and Newly Exposed to Non Steroidal Anti-Inflammatory Drugs: A Cohort Study

Laboratory Monitoring of Patients Treated with Antihypertensive Drugs and Newly Exposed to Non Steroidal Anti-Inflammatory Drugs: A Cohort Study

Safe use of NSAIDs and RAS-inhibitors at Agogo Presbyterian Hospital, Ghana

Nierinsufficiëntie en medicatie

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