Medication Safety Principles and Practice in CKD

Abstract

Ensuring patient safety is a priority of medical care because iatrogenic injury has been a primary concern. Medications are an important source of medical errors, and kidney disease is a thoroughfare of factors threatening safe administration of medicines. Principal among these is reduced kidney function because almost half of all medications used are eliminated the kidney. Additionally, kidney patients often suffer from multimorbidity, including diabetes, hypertension, and heart failure, with a range of prescribers who often do not coordinate treatments. Patients with kidney disease are also susceptible to further kidney injury and metabolic derangements from medications, which can worsen the disease. In this review, we will present the key issues and threats to safe medication use in kidney disease, with a focus on predialysis CKD, as the scope of medication safety in ESKD and transplantation are unique and deserve their own consideration. We discuss drugs that need to be avoided or dose modified, and review the complications of a range of medications routinely administered in CKD, as these also call for cautious use.

Coordinated‐Transitional Care for Veterans with Heart Failure and Chronic Lung Disease

“…A geriatric pharmacist (C.H.) reviewed the records of the 181 C‐TraC patients who had complete medication reconciliation to assess the quality of the RN‐CM's reconciliation, noting the number and type of discrepancy according to published methods and identifying potentially inappropriate or high‐risk medications . The 150 discrepancies noted by the RN‐CM were confirmed, and the pharmacist identified an additional 31.…”

“…reviewed the records of the 181 C-TraC patients who had complete medication reconciliation to assess the quality of the RN-CM's reconciliation, noting the number and type of discrepancy according to published methods 15 and identifying potentially inappropriate or high-risk medications. [16][17][18] The 150 discrepancies noted by the RN-CM were confirmed, and the pharmacist identified an additional 31. On root cause analysis, 82% were attributed to the discharge process (improper medication reconciliation, changes not discussed with patients, confusion about changes, and planned medications not received), 14% to patient factors (taking medications differently than described or refusing to take them), and 4% to other factors.…”

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

“…These classes of drugs not only lower blood pressure but also decrease the progression of albuminuria [3]. Statin therapy is recommended in patients with CKD and aged 50 years or older as it reduces cardiovascular risk and progression of CKD [5,6]. Australian guidelines also recommend avoiding the use of medications that can potentially damage kidney function or readily accumulate and cause toxicity [6].…”

“…Statin therapy is recommended in patients with CKD and aged 50 years or older as it reduces cardiovascular risk and progression of CKD [5,6]. Australian guidelines also recommend avoiding the use of medications that can potentially damage kidney function or readily accumulate and cause toxicity [6]. These medications include non-steroidal anti-inflammatory drugs (NSAID), metformin, and a high dose of digoxin [3].…”

Adverse Safety Event Characteristics and Predictive Factors in Hospital Encounters for Patients with Chronic Kidney Disease

“…In addition, patients with CKD may experience actionable safety findings (defined as objective clinical findings, such as laboratory values, with the potential for injury or disease exacerbation needing intervention and monitoring [7,8]. A twofold increase over time in the period prevalence rate of CKD (11.8% in 2007 to 23.1% in 2016) places more individuals at risk for an ASE [9].…”