Adverse Drug Events in Patients with Chronic Kidney Disease Associated with Multiple Drug Interactions and Polypharmacy

Sommer, Julia; Seeling, Andreas; Rupprecht, Harald

doi:10.1007/s40266-020-00747-0

Cited by 44 publications

(37 citation statements)

References 48 publications

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“…Our results indicated that more than one-quarter (26.4%) of the dispensed QTcP-inducing drugs were prescribed based on inappropriate decision, and this was significantly associated with urology clinics. A recent study conducted in Germany, found that inappropriate prescribing can lead to negative adverse drug events including QTcP, hyperkalaemia and haemorrhage in patients with kidney diseases (46). Lower rate of inappropriate prescribing was found in the USA (47).…”

Section: Discussionmentioning

confidence: 99%

Drugs-Induced QT Interval Prolongation among End-Stage Renal Disease Patients in Jordan

Naser

2020

Preprint

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Background In spite of high risk of mortality due to drug-induced QT interval prolongation (QTcP) usage among end stage renal disease patients (ESRD), no previous studies were conducted to assess medication safety of this drugs category among this vulnerable patients group. Objectives This study aimed to investigate the appropriateness and potential drug-drug interactions of QTcP-inducing drugs among ESRD patients in Jordan. Method This study was a cross-sectional retrospective study conducted in the outpatient clinics of 200 Jordanian healthcare facilities over three years (2017, 2018, and 2019) using Hakeem© database for data collection. CredibleMeds© was used to identify and categorise QTcP-inducing drugs. Drug-drug interactions and appropriateness of prescribing were assessed by Micromedex Drug Reax© software and a multidisciplinary committee, respectively. Results Of the 407 patients included, 954 drugs with risk of QTcP were dispensed; 618 (64.8%) had interactions with other drugs; 10.4% were major, 29.3% were moderate, and 60.3% were minor drug-drug interactions. Absence of major polypharmacy and co-morbidity decreased the odds of major drug-drug interactions by 61% (OR 0.61; 95% CI 0.23-0.97; p=0.02), and 72% (OR 0.72; 95% CI 0.44-1.23; p=0.04), respectively. After clinical evaluation, 17.6% of the dispensed drugs were considered inappropriate application, 12.9% were classified as inappropriate choice, and 26.4% were judged as inappropriate decision. Urology clinics were more likely to prescribe QTcP-inducing drugs based on inappropriate decision. Conclusion Major drug-drug interactions and dispensing medications with risk of QTcP based on inappropriate prescribing decisions for patients with ESRD were reported to be high in outpatient clinics in Jordan.

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Section: Discussionmentioning

confidence: 99%

Drugs-Induced QT Interval Prolongation among End-Stage Renal Disease Patients in Jordan

Naser

2020

Preprint

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“…Several studies refer to potentially inappropriate prescribing in secondary care, [26][27][28] while few studies examine primary care prescribing. A recent primary care based study by Wood et al reported prescribing outside recommendations in 2.0 -39.9% in a sample of eight drugs.…”

Section: Comparison With Existing Literaturementioning

confidence: 99%

Potentially inappropriate primary care prescribing in people with chronic kidney disease: a cross-sectional analysis of a large population cohort

2020

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Background: Many drugs should be avoided or require dose-adjustment in chronic kidney disease (CKD). Previous estimates of potentially inappropriate prescribing rates have been based on data on a limited number of drugs and mainly in secondary care settings. Aim: To determine the prevalence of contraindicated and potentially inappropriate primary care prescribing in a complete population of people with CKD. Method: Cross-sectional study of prescribing patterns in a complete geographical population of people with CKD defined using laboratory data. Drugs were organised by British National Formulary advice. Contraindicated (CI) drugs: “avoid”. Potentially high risk (PHR) drugs: “avoid if possible”. Dose inappropriate (DI) drugs: dose exceeded recommended maximums. Results: 28,489 people with CKD were included in analysis, of whom 70.0% had CKD 3a, 22.4% CKD 3b, 5.9% CKD 4, and 1.5% CKD 5. 3.9% (95%CI 3.7-4.1) of people with CKD stages 3a-5 were prescribed one or more CI drug, 24.3% (95%CI 23.8-24.8) PHR drug, and 15.2% (95% CI 14.8-15.62) DI drug. CI drugs differed in prevalence by CKD stage, and were most commonly prescribed in CKD stage 4 with a prevalence of 36.0% (95%CI 33.7–38.2). PHR drugs were commonly prescribed in all CKD stages ranging from 19.4% (95%CI 17.6-21.3) in stage 4 to 25.1% (95%CI 24.5–25.7) in stage 3b. DI drugs were most commonly prescribed in stage 4, 26.4% (95%CI 24.3-28.6). Conclusion: Potentially inappropriate prescribing is common at all stages of CKD. Development and evaluation of interventions to improve prescribing safety in this high-risk populations are needed.

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“…While intended to be beneficial to the overall health of the patient, complicated medication regimens can lead to medication therapy problems, contribute to poor health outcomes, and pose financial burdens to patients. 4 Example of medication therapy problems are described in Table 1.…”

Section: Introductionmentioning

confidence: 99%

“…This medication regimen typically consists of medications intended to slow progression of kidney disease, treatments for complications associated with kidney disease, and medications for other comorbid conditions. While intended to be beneficial to the overall health of the patient, complicated medication regimens can lead to medication therapy problems, contribute to poor health outcomes, and pose financial burdens to patients 4 . Example of medication therapy problems are described in Table 1.…”

Section: Introductionmentioning

confidence: 99%

Medication management in dialysis: Barriers and strategies

Cardone

Parker

2020

Seminars in Dialysis

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People with end-stage kidney disease (ESKD) who require chronic dialysis are often reliant on complicated medication regimens to manage their health conditions. Due to the complexities of the advanced kidney disease, underlying comorbidities, and special instructions, medication regimens for patients on dialysis put patients at high risk for medication therapy problems related to safety, effectiveness, appropriateness, and adherence. This article explores the factors that affect optimal medication use for people on dialysis, including the broader drug use system, and offers recommendations around medication reconciliation, medication review, deprescribing, and considering social determinants of health to improve medication management among patients with ESKD.

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Adverse Drug Events in Patients with Chronic Kidney Disease Associated with Multiple Drug Interactions and Polypharmacy

Cited by 44 publications

References 48 publications

Drugs-Induced QT Interval Prolongation among End-Stage Renal Disease Patients in Jordan

Drugs-Induced QT Interval Prolongation among End-Stage Renal Disease Patients in Jordan

Potentially inappropriate primary care prescribing in people with chronic kidney disease: a cross-sectional analysis of a large population cohort

Medication management in dialysis: Barriers and strategies

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