Large variations in prescriptions of gastrointestinal medications in hemodialysis patients on three continents: The Dialysis Outcomes and Practice Patterns Study (DOPPS)

Abstract

Little is known about proton pump inhibitor (PPI) or H(2) receptor antagonist (HA) prescription patterns or regarding use of predictors in hemodialysis patients. Proton pump inhibitor and HA prescribing patterns were investigated in 8628 hemodialysis patients from seven countries enrolled in the prospective, observational Dialysis Outcomes and Practice Patterns Study. Logistic regression examined predictors associated with PPI and HA use, adjusting for age, sex, country, time with end-stage renal disease, medications, 14 comorbid conditions, and the association between the number of comorbid conditions and the prescription of gastrointestinal (GI) medications. In a cross-section from February 1, 2000, 3.4% to 36.9% of patients received an HA and 0.8% to 26.9% took a PPI, depending upon the country. From 1996 to 2001, the prescription of HAs declined while PPI use increased. Facility use of HAs and PPIs ranged from 0% to 94% of patients. H2 receptor antagonist or PPI use was significantly and independently associated with age, narcotic use, corticosteroids, acetaminophen, nonsteroidal anti-inflammatory drugs, tricyclic antidepressants, selective serotonin reuptake inhibitors, coronary artery disease history, cardiovascular diseases other than hypertension or congestive heart failure, peripheral vascular disease, pulmonary disease, and GI bleed. Proton pump inhibitors or HAs were more likely to be prescribed in Italy, Spain, and the United Kingdom than in the United States. The odds of PPI prescription increased if serum phosphorus <5.5 mEq/L or serum albumin <3.5 g/dL. Prescription of GI medications was associated with many comorbidities and use of several medications. Extreme variability of prescription patterns suggests that there is no standard approach in treatment practices.

Opioid and Benzodiazepine Use in End-Stage Renal Disease

“…Interestingly, estimates that appeared to be obtained from the same cohort of patients were not always similar. Bailie et al (21) reported a prevalence of 9% (95% CI, 8.9 to 10.1%) in DOPPS I from 1996 to 2001, whereas Elder et al (20) reported an estimate of 28% (95% CI, 27.1 to 29.3%) from the same database as of 2000. These variable prevalence estimates did not correlate with time period, dialysis vintage, or sample size (data not shown).…”

“…Five were from the United States (1,13,17,24,25), one was from Canada (7), and one was from Belgium (19). The remaining three included cross-sections of patients from between 7 and 12 countries (Dialysis Outcomes and Practice Patterns Study [DOPPS] I and II) (20,21,23). Two of the DOPPS I studies reported on similar cohorts of patients (20,21) (Figure 2).…”

“…The remaining three included cross-sections of patients from between 7 and 12 countries (Dialysis Outcomes and Practice Patterns Study [DOPPS] I and II) (20,21,23). Two of the DOPPS I studies reported on similar cohorts of patients (20,21) (Figure 2). In total, there were Ͼ26,000 unique patients from 1995 to 2004, and Ͼ90% of these patients were receiving hemodialysis.…”

“…Fifteen articles met inclusion criteria (1,7,(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25) (Figure 1). Agreement beyond chance between the two authors for article inclusion was good (kappa ϭ 0.79).…”

Use of Trastuzumab for Metastatic Breast Cancer in Australia: Interpreting Findings From a Cohort of 1,469 Women on a National Access Program Versus 41 Women Treated by Two Medical Oncologists

“…Chan A, Untch M, Petruzelka L, et al: Navelbine and trastuzumab combination as first line therapy for HER 2-overexpressing metastatic breast cancer (HER2 ϩ MBC) is a highly active and safe regimen: Final results of multinational trial. Presented at 25th Annual San Antonio Breast Cancer Symposium, December [3][4][5][6]2003 1 The authors suggest that we have significantly underestimated the level of cardiac monitoring and overestimated the level of "off-label" trastuzumab use. They also question our interpretation of the findings in relation to the longer duration of trastuzumab therapy in actual practice versus that observed on trial.…”