Adverse safety events in patients with Chronic Kidney Disease (CKD)

Abstract

Chronic kidney disease (CKD) confers a higher risk of adverse safety events as a result of many factors including medication dosing errors and use of nephrotoxic drugs, which can cause kidney injury and renal function decline. CKD patients may also have comorbidities such as hypertension and diabetes for which they require more frequent care from different providers, and for which standard, but countervailing treatments, may put them at risk for adverse safety events. Areas covered: In addition to the well-known agents such as iodinated radiocontrast, antimicrobials, diuretics and angiotensin converting enzyme (ACE) inhibitors which can directly affect renal function, safety considerations in the treatment of common CKD complications such as anemia, diabetes, analgesia and thrombosis will also be discussed. Expert opinion: Better outcomes in CKD may be achieved by alerting care providers to the special care needs of kidney patients and encouraging patients to self-manage their disease with the decision support of multidisciplinary patient care teams.

Long-Term, Real-World Safety and Efficacy of Teneligliptin: A Post-Marketing Surveillance of More Than 10,000 Patients with Type 2 Diabetes in Japan

“…In the present surveillance, the incidences of overall ADRs, particularly for ADRs related to renal impairment, and serious ADRs were numerically greater in the G4 and G5 subgroups than in the G1 subgroup. Patients with renal impairment are generally more prone to AEs due to multiple factors including comorbidities and the need for polypharmacy [51]. Indeed, in RUBY, the rate of comorbidities was higher in patients with advanced renal impairment.…”

Improving hospital safety for patients with chronic kidney disease: a mixed methods study

“…The complexity of this disease and its medical management predispose individuals to further complications of the cardiovascular and renal systems [3,4]. Underrecognition of impaired kidney functioning [5][6][7][8][9], presence of multiple comorbid conditions [3,5,10], and polypharmacy associated with management of comorbidities [6] often culminate in frequent hospital admissions. In a population of pre-dialysis patients with CKD in the Safe Kidney Care (SKC) Cohort Study, Ginsberg et al [4] reported that 70 % experienced at least one adverse safety incident or actionable safety finding, while over one-third had two or more.…”

The Role of Opioids in Pain Management in Elderly Patients with Chronic Kidney Disease: A Review Article

“…Acetaminophen was the most usually used pain-relieving (34% of the entire CKD cohort), although the higher doses of acetaminophen used chronically have been accompanied by analgesic nephropathy (96). To avoid toxicity, it is proposed to not exceed 3 g/day of acetaminophen (97). For moderate pain, tramadol is preferred, given its low risk of direct nephrotoxicity (98).…”

“…For moderate pain, tramadol is preferred, given its low risk of direct nephrotoxicity (98). The use of fentanyl, alfentanil, and hydromorphone is relatively safe in dialysis patients, but doses should be adjusted to minimize the risk of respiratory depression (97). However, adjuvant medications are useful for improving pain scores, decreasing opioid doses, and treating neuropathic components of pain in dialysis patients (99).…”