Impact of Adverse Drug Reactions in Patients with End Stage Renal Disease in Greece

Spanakis, Marios; Roubedaki, Marianna; Tzanakis, Ioannis; Zografakis-Sfakianakis, Michail; Patelarou, Evridiki; Patelarou, Athina

doi:10.3390/ijerph17239101

Cited by 11 publications

(9 citation statements)

References 50 publications

(63 reference statements)

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“…The analysis of the DDIs and their clinical significance have been previously presented [ 29 , 30 ]. Briefly, medication regimens were recorded and DDIs were detected using available online drug interaction checker tools (Medscape and Drugs.com; accessed on 1 April till 30 July 2022), considering the level of evidence available in the literature describing the significance, such as experts’ opinions, in silico, in vitro, in vivo data, clinical studies, reviews, the Summary of Product Characteristics (SmPC), and reports from regulatory authorities.…”

Section: Methodsmentioning

confidence: 99%

Drug-Drug Interactions among Patients Hospitalized with COVID-19 in Greece

Spanakis

Ιωάννου

Tzalis

et al. 2022

JCM

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The modulation of the pharmacological action of drugs due to drug-drug interactions (DDIs) is a critical issue in healthcare. The aim of this study was to evaluate the prevalence and the clinical significance of potential DDIs in patients admitted to the University Hospital of Heraklion in Greece with coronavirus disease 2019 (COVID-19). Cardiovascular disorders (58.4%) and diabetes (types I and II) (29.6%) were the most common comorbidities. A high occurrence of DDIs was observed, and clinically significant DDIs that may hamper response to treatment represented 40.3% of cases on admission, 21% during hospitalization, and 40.7% upon discharge. Polypharmacy and comorbidities were associated with a higher prevalence of DDIs in a statistically significant way (p < 0.05, 95% CI). Clinically significant DDIs and increased C-reactive protein values upon admission were associated with prolonged hospitalization. The results reveal that patients admitted due to COVID-19 in Greece often have an additional burden of DDIs that healthcare teams should approach and resolve.

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Section: Methodsmentioning

confidence: 99%

Drug-Drug Interactions among Patients Hospitalized with COVID-19 in Greece

Spanakis

Ιωάννου

Tzalis

et al. 2022

JCM

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“…A study of patients with ESKD found that 75% of the cohort had potential drug-drug interactions, with approximately half of them classified as “serious” or “needing close monitoring”; they found a non-statistically significant association between the number of drug-drug interactions and the occurrence of ADEs. 17 Chronic PIMs are also associated with an increased length of hospital stay and a higher risk of death among patients with CKD of all stages. 18 , 19 As such, identifying and deprescribing PIMs are an important intervention to reduce pill burden, decrease individual and societal-level drug costs, improve quality of life, and decrease ADEs and premature or preventable death.…”

Section: Introductionmentioning

confidence: 99%

Deprescribing Opportunities for Hospitalized Patients With End-Stage Kidney Disease on Hemodialysis: A Secondary Analysis of the MedSafer Cluster Randomized Controlled Trial

Moryousef

Bortolussi‐Courval

Podymow

et al. 2022

Can J Kidney Health Dis

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Background: End-stage kidney disease patients on dialysis have a substantial risk of polypharmacy due their propensity for comorbidity and contact with the health care system. MedSafer is an electronic decision support tool that integrates patient comorbidity and medication lists to generate personalized deprescribing reports focused on identifying potentially inappropriate medications (PIMs). Objective: To conduct a secondary analysis of patients on regular hemodialysis included in the MedSafer randomized controlled trial to investigate the patterns of polypharmacy and evaluate the efficacy of the MedSafer deprescribing algorithms. Design: Secondary analysis of a cluster randomized clinical trial. Setting: Medical units in 11 acute care hospitals in Canada. Patients: The MedSafer trial enrolled 5698 participants with an expected prognosis of >3 months, age 65 years and older, and on 5 or more daily home medications; 140 participants were receiving chronic hemodialysis. Measurements: The primary outcome of the trial was 30-day adverse drug events (ADEs) post-hospital discharge, and a key secondary outcome was deprescribing. Methods: Control patients received usual care (medication reconciliation), whereas clinicians caring for intervention patients received a MedSafer report that highlighted individualized opportunities for deprescribing. Results: There were 70 patients in each of the control and intervention arms. The median number of home medications was 14 (compared with a median of 10 medications in the general trial population). The most frequent medications observed that were potentially inappropriate were proton pump inhibitors (potentially inappropriate in 55/76 users; 72.4%), diabetes medications in patients with a HBA1C <7.5% (36/65 users; 55.4%), docusate (27/27 users; 100%), gabapentinoids (27/36 users; 75%), and combination antiplatelet/anticoagulants (22/97 users; 22.7%). The proportion of PIMs deprescribed was higher during the intervention phase (28.8% vs 19.3%; absolute increase 9.4% [95% confidence interval 1.3%-17.6%]) compared with the control phase. There was no observed difference in ADEs at 30-day post-discharge between the control and the intervention groups. The most common ADE (n = 3) was gastrointestinal bleeding attributed to antiplatelet agents. Limitations: This was a post hoc exploratory analysis, the original trial did not stratify by hemodialysis status, and the small sample size precludes drawing any definitive conclusions. Conclusion: MedSafer facilitates deprescribing in hospitalized patients on hemodialysis. Larger-scale implementation of decision support software for deprescribing in dialysis and long-term follow-up are likely required to demonstrate an impact on ADEs.

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“…Furthermore, ADRs are prevalent, frequently serious, and potentially preventable in CKD patients [9]. Therefore, assessing the causality, severity, and preventability of ADRs is essential to reduce the likelihood of associated complications [10].…”

Section: Introductionmentioning

confidence: 99%

Evaluation of Drug-Related Problems in Chronic Kidney Disease Patients

Shouqair¹,

Rabbani²,

Sridhar³

et al. 2022

Cureus

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BackgroundChronic kidney disease (CKD) is a challenging global health problem with increasing prevalence worldwide. Concurrence of CKD and comorbidities results in the use of multiple medications and exposing patients to polypharmacy. Polypharmacy in CKD is common across all the stages of the disease and leads to poor medication adherence, higher healthcare costs, and drug-related problems, such as drug-drug interactions (DDIs) and adverse drug reactions (ADRs). DDIs and ADRs in CKD patients may lower the quality of life, increase the length of hospital stay, and augment the risks of morbidity and mortality. MethodologyThis was a hospital-based, prospective, cross-sectional study conducted in a secondary care hospital. The study population comprised 130 adult CKD patients admitted to the nephrology department including those on maintenance hemodialysis. Study-related data were obtained from the electronic patient case records. Medications prescribed to the patients were analyzed for potential DDIs (pDDIs) using Portable Emergency and Primary Care Information Database (PEPID 12.1) drug interaction checker. All observed and reported suspected ADRs related to the prescribed drugs were evaluated for causality, severity, preventability, and predictability. ResultsOut of the 130 patients, majority were males (n = 71, 54.6%), in the age group of 61-70 years (n = 45, 34.6%), and belonged to CKD stage 5 (n = 105, 80.8%). The mean number of drugs prescribed was 11.1 ± 3.8 per patient. The prevalence of pDDIs was found to be 89.2%. Upon analysis by the PEPID database, 708 pDDIs with 215 different pairs of interacting drugs were identified. Polypharmacy (odds ratio (OR): 62.34, 95% confidence interval (CI): 7.97-487.64, p < 0.001) was identified as an independent predictor of the occurrence of pDDIs. Negative binomial regression analysis revealed that dyslipidemia (incidence rate ratio (IRR): 2.7, 95% CI 2.09-3.48, p < 0.001) and diabetes (IRR: 1.2, 95% CI 1.01-1.54, p = 0.040) increased the probability of occurrence of pDDI by 2.7 and 1.2 folds, respectively. Furthermore, the likelihood of pDDI increased with every one-day increase in the length of hospital stay (IRR: 1.02, 95% CI 1.00-1.03, p = 0.015) by 1.02 times and polypharmacy (IRR: 6.30, 95% CI 3.04-13.02, p < 0.001) by 6.3 times. The incidence of ADRs was found to be 10.7%. Majority of suspected ADRs were possible (n = 7, 50.0%), of mild and moderate severity (n = 7, 50.0%), and non-preventable (n = 8, 57.1%) type. ConclusionsThis study investigated two important drug-related problems, pDDIs, and ADRs, in the CKD population. High proportion of CKD patients in the study had pDDIs. Comorbid conditions such as dyslipidemia and diabetes mellitus, length of hospital stay, and polypharmacy were significantly associated with increased likelihood of pDDIs. Furthermore, there was a burden of ADRs in the study population, of which most ADRs were possible and of mild to moderate severity. Prevention, identification, and resolution of these problems in CKD patients is important...

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Impact of Adverse Drug Reactions in Patients with End Stage Renal Disease in Greece

Cited by 11 publications

References 50 publications

Drug-Drug Interactions among Patients Hospitalized with COVID-19 in Greece

Drug-Drug Interactions among Patients Hospitalized with COVID-19 in Greece

Deprescribing Opportunities for Hospitalized Patients With End-Stage Kidney Disease on Hemodialysis: A Secondary Analysis of the MedSafer Cluster Randomized Controlled Trial

Evaluation of Drug-Related Problems in Chronic Kidney Disease Patients

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