Epidemiology of chronic kidney disease in Australian general practice: National Prescribing Service MedicineWise MedicineInsight dataset

Radford, Jan; Kitsos, Alex; Stankovich, Jim; Castelino, Ronald L.; Khanam, Masuma Akter; Jose, Matthew; Peterson, Gregory M.; Saunder, Timothy; Wimmer, Barbara C.; Razizaidi, Tabish

doi:10.1111/nep.13537

Cited by 29 publications

(43 citation statements)

References 19 publications

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“…A total of 2,974,031 included patients had at least three clinical encounters in the previous two years. Details about this dataset can be found elsewhere [2,[14][15][16]. We used MedicineInsight data collected from 329 general practices between 1 January 2013 and 1 June 2016.…”

Section: Methodsmentioning

confidence: 99%

“…This study had a large sample size, and patient characteristics within the MedicineInsight dataset are similar to the Australian population [2,14,16]. However, there are several limitations.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

“…Diabetes and hypertension caused up to two-thirds of CKD cases. Approximately one in three and three in four Australian general practice patients with CKD had recorded diagnoses of diabetes and hypertension, respectively [2]. Progressive kidney damage with hypertension and diabetes leads to end-stage kidney disease (ESKD) [3].…”

Section: Introductionmentioning

confidence: 99%

“…Prevention of CKD progression is cost-effective and is most successful within primary care [3]. In Australia, the majority of patients with CKD stages 3-5 receive treatment from general practices [2]. Prevention of CKD progression can be achieved by treatment of modifiable risk factors and avoidance of nephrotoxic medication [3].…”

Section: Introductionmentioning

confidence: 99%

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Medication Prescribing Quality in Australian Primary Care Patients with Chronic Kidney Disease

Bezabhe

Kitsos

Saunder

et al. 2020

JCM

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Background: Australian patients with chronic kidney disease (CKD) are routinely managed in general practices with multiple medications. However, no nationally representative study has evaluated the quality of prescribing in these patients. The objective of this study was to examine the quality of prescribing in patients with CKD using nationally representative primary care data obtained from the NPS MedicineWise’s dataset, MedicineInsight. Methods: A cross-sectional analysis of general practice data for patients aged 18 years or older with CKD was performed from 1 February 2016 to 1 June 2016. The study examined the proportion of patients with CKD who met a set of 16 published indicators in two categories: (1) potentially appropriate prescribing of antihypertensives, renin-angiotensin system (RAS) inhibitors, phosphate binders, and statins; and (2) potentially inappropriate prescribing of nephrotoxic medications, such as non-steroidal anti-inflammatory drugs (NSAIDs), at least two RAS inhibitors, triple therapy (an NSAID, a RAS inhibitor and a diuretic), high-dose digoxin, and metformin. The proportion of patients meeting each quality indicator was stratified using clinical and demographic characteristics. Results: A total of 44,259 patients (24,165 (54.6%) female; 25,562 (57.8%) estimated glomerular filtration (eGFR) 45–59 mL/1.73 m2) with CKD stages 3–5 were included. Nearly one-third of patients had diabetes and were more likely to have their blood pressure and albumin-to-creatinine ratio monitored than those without diabetes. Potentially appropriate prescribing of antihypertensives was achieved in 79.9% of hypertensive patients with CKD stages 4–5. The prescribing indicators for RAS inhibitors in patients with microalbuminuria and diabetes and in patients with macroalbuminuria were achieved in 69.9% and 62.3% of patients, respectively. Only 40.8% of patients with CKD and aged between 50 and 65 years were prescribed statin therapy. The prescribing of a RAS inhibitor plus a diuretic was less commonly achieved, with the indicator met in 20.6% for patients with microalbuminuria and diabetes and 20.4% for patients with macroalbuminuria. Potentially inappropriate prescribing of NSAIDs, metformin, and at least two RAS inhibitors were apparent in 14.3%, 14.1%, and 7.6%, respectively. Potentially inappropriate prescribing tended to be more likely in patients aged ≥65 years, living in regional or remote areas, or with socio-economic indexes for areas (SEIFA) score ≤ 3. Conclusions: We identified areas for possible improvement in the prescribing of RAS inhibitors and statins, as well as deprescribing of NSAIDs and metformin in Australian general practice patients with CKD.

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Section: Methodsmentioning

confidence: 99%

Section: Strengths and Limitationsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Medication Prescribing Quality in Australian Primary Care Patients with Chronic Kidney Disease

Bezabhe

Kitsos

Saunder

et al. 2020

JCM

Self Cite

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“…As of July 2017, MedicineInsight had recruited 650 general practices with data pertaining to 3.6 million patients. [3,7,8] The Institutional Human Research Ethics Committee approved the study (H0015651). The study is reported as per the reporting of studies conducted using observational routinely collected health data statement for pharmacoepidemiology (RECORD-PE) guideline.…”

Section: Methodsmentioning

confidence: 99%

Quality Use Of Medicines In Patients With Chronic Kidney Disease

Castelino

Saunder

Kitsos

et al. 2020

Preprint

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Background: Chronic kidney disease (CKD) affects drug elimination and patients with CKD require appropriate adjustment of renally cleared medications to ensure safe and effective pharmacotherapy. The main objective of this study was to determine the extent of potentially inappropriate prescribing (PIP; defined as the use of a contraindicated medication or inappropriately high dose according to the kidney function) of renally-cleared medications commonly prescribed in Australian primary care, based on two measures of kidney function. A secondary aim was to assess agreement between the two measures.Methods Retrospective analysis of routinely collected de-identified Australian general practice patient data (NPS MedicineWise MedicineInsight from January 1, 2013, to June 1, 2016; collected from 329 general practices). All adults (aged ≥18 years) with CKD presenting to general practices across Australia were included in the analysis. Patients were considered to have CKD if they had two or more estimated glomerular filtration rate (eGFR) recorded values <60 mL/min/1.73m2, and/or two urinary albumin/creatinine ratios ≥3.5 mg/mmol in females (≥2.5 mg/mmol in males) at least 90 days apart. PIP was assessed for 49 commonly prescribed medications using the Cockcroft-Gault (CG) equation/eGFR as per the instructions in the Australian Medicines Handbook. Results: A total of 48,731 patients met the Kidney Health Australia (KHA) definition for CKD and had prescriptions recorded within 90 days of measuring serum creatinine (SCr)/estimated glomerular filtration rate (eGFR). Overall, 28,729 patients were prescribed one or more of the 49 medications of interest. Approximately 35% (n=9,926) of these patients had at least one PIP based on either the Cockcroft-Gault (CG) equation or eGFR (CKD-EPI; CKD-Epidemiology Collaboration Equation). There was good agreement between CG and eGFR while determining the appropriateness of medications, with approximately 97% of the medications classified as appropriate by eGFR also being considered appropriate by the CG equation. Conclusion: This study highlights that PIP commonly occurs in primary care patients with CKD and the need for further research to understand why and how this can be minimised. The findings also show that the eGFR provides clinicians a potential alternative to the CG formula when estimating kidney function to guide drug appropriateness and dosing.

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The Prevalence of CKD in Australian Primary Care: Analysis of a National General Practice Dataset

Jun,

Wick,

Neuen

et al. 2024

Kidney International Reports

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Epidemiology of chronic kidney disease in Australian general practice: National Prescribing Service MedicineWise MedicineInsight dataset

Cited by 29 publications

References 19 publications

Medication Prescribing Quality in Australian Primary Care Patients with Chronic Kidney Disease

Medication Prescribing Quality in Australian Primary Care Patients with Chronic Kidney Disease

Quality Use Of Medicines In Patients With Chronic Kidney Disease

The Prevalence of CKD in Australian Primary Care: Analysis of a National General Practice Dataset

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