Patterns of medication use in the RRI-CKD study: focus on medications with cardiovascular effects

Bailie, George R.; Eisele, George; Liu, Lei; Roys, Erik; Kiser, Margaret; Finkelstein, Frederick; Wolfe, Robert A.; Port, Friedrich K.; Burrows-Hudson, Sally; Saran, Rajiv

doi:10.1093/ndt/gfh771

Cited by 106 publications

(107 citation statements)

References 16 publications

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“…23 There was a predominance of male subjects, which was similar to the results of previous reports. 20,23 The study population included mostly Malays, since our setting was the northeastern peninsular Malaysia, more specifically the States of Kelantan, Terengganu and Pahang. There is a wide variation in the prevalence of anemia and its severity in CKD patients.…”

Section: Discussionsupporting

confidence: 91%

“…Nonetheless, the use of oral iron therapy in this study was greater than previously reported. 23 Ferrous fumarate (325 mg once daily) and folic acid (5 mg once daily) were the predominantly prescribed oral iron supplement combination for the treatment of anemia in our cohort. Underutilization of erythropoietin stabilizing agents in the current study might also be attributable to physician inertia or its prohibitive cost.…”

Section: Discussionmentioning

confidence: 89%

“…Our study proposes that there is room for substantial improvement in terms of anemia control. Bailie et al 23 reported that the positive predictors of iron use in pre-dialysis patients were Caucasians [odds ratio (OR) = 2.6] and diabetics (OR = 2.1). Contrary to these findings, we found that the significant predictors of anti-anemic therapy prescribed were decreased HCT and Hb level, and increased severity of CKD.…”

Section: Discussionmentioning

confidence: 99%

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Prevalence and management of anemia in pre-dialysis Malaysian patients: A hospital-based study

Salman

Khan

Adnan

et al. 2016

Rev. Assoc. Med. Bras.

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Summary Objective: Anemia, a common complication of chronic kidney diseases (CKD), is involved in significant cardiovascular morbidity. Therefore, the objective of our study was to investigate the prevalence and severity of anemia in pre-dialysis patients, as well as to determine the predictors of anti-anemic therapy. Method: A retrospective, observational study was conducted on adult pre-dialysis patients receiving treatment at the Hospital Universiti Sains Malaysia from January 2009 to December 2013. Results: A total of 615 eligible cases were included. The mean age of patients was 64.1±12.0 years. The prevalence of anemia was 75.8%, and the severity of anemia was mild in 47.7% of the patients, moderate in 32.2%, and severe in 20%. Based on morphological classification of anemia, 76.9% of our patients had normochromic-normocytic anemia whereas 21.8 and 1.3% had hypochromic-microcytic anemia and macrocytic anemia, respectively. Oral iron supplements were prescribed to 38.0% of the patients and none of the patients was given erythropoietin stabilizing agents (ESA) or intravenous iron preparations. In logistic regression, significant predictors of anti-anemic preparation use were decreased hemoglobin and hematocrit, and advanced stages of CKD. Conclusion: The results of the present study suggest that the prevalence of anemia in pre-dialysis patients is higher than currently accepted and it is found to be correlated with renal function; prevalence increases with declined renal function. An earlier identification as well as appropriate management of anemia will not only have a positive impact on quality of life but also reduce hospitalizations of CKD patients due to cardiovascular events.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 89%

Section: Discussionmentioning

confidence: 99%

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Prevalence and management of anemia in pre-dialysis Malaysian patients: A hospital-based study

Salman

Khan

Adnan

et al. 2016

Rev. Assoc. Med. Bras.

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“…Importantly, patients with medication discrepancies are more likely to be readmitted (19). In addition, established practices for kidney disease management are vastly underused (20)(21)(22)(23). A recent survey of internal medicine residents found deficits in almost every domain of knowledge about CKD complications and management (24).…”

Section: Discussionmentioning

confidence: 99%

Risks of Subsequent Hospitalization and Death in Patients with Kidney Disease

Daratha

Short

Corbett

et al. 2012

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives Rates of hospitalization are known to be high in patients with kidney disease. However, ongoing risks of subsequent hospitalization and mortality are uncertain. The primary objective was to evaluate patients with kidney disease for long-term risks of subsequent hospitalization, including admissions resulting in death. (n=6131), kidney transplant (n=1100), and reference (n=641,242) cohorts. Cox proportional hazard models controlling for age, sex, payer, comorbidity, previous hospitalization, primary diagnosis category, and length of stay were conducted for time to event analyses.Results Compared with the reference cohort, risks for subsequent hospitalization were increased in the CKD (hazard ratio=1.20, 99% confidence interval=1.18-1.23, P,0.001), dialysis (hazard ratio=1.76, 99% confidence interval=1.69-1.83, P,0.001), and kidney transplant (hazard ratio=1.85, 99% confidence interval=1.68-2.03, P,0.001) cohorts, with a mean follow-up time of 29 months. Similarly, risks for fatal hospitalization were increased for patients in the CKD (hazard ratio=1.41, 99% confidence interval=1.34-1.49, P,0.001), dialysis (hazard ratio=3.04, 99% confidence interval=2.78-3.31, P,0.001), and kidney transplant (hazard ratio=2.25, 99% confidence interval=1.67-3.03, P,0.001) cohorts. Risks for hospitalization and fatal hospitalization increased in a graded manner by CKD stage.Conclusions Risks of subsequent hospitalization, including admission resulting in death, among patients with kidney disease were substantially increased in a large statewide population. Patients with kidney disease should be a focus of efforts to reduce hospitalizations and mortality.

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“…Philipneri and colleagues observed that 50% of CKD patients followed by nephrologists and 30% of patients followed by physicians other than nephrologists were using RAAS blockers. 19 Bailie et al 20 reported in their trial that 44% of patients with stage 2-5 CKD were using angiotensin-converting-enzyme inhibitor (ACEI) and 13% were using angiotensin receptor blocker (ARB). In another study, the prevalence of RAAS blocker use was found to be 64.5% in patients with GFR <75 mL/min.…”

Section: Discussionmentioning

confidence: 99%

Major Barriers against Renin–Angiotensin–Aldosterone System Blocker Use in Chronic Kidney Disease Stages 3–5 in Clinical Practice: A Safety Concern?

et al. 2012

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Renin-angiotensin-aldosterone system (RAAS) blockers are underutilized in patients with chronic kidney disease (CKD). We aimed to determine barriers against the use of RAAS blockers in these patients. Patients with stage 3-5 CKD referred to Hacettepe University Hospital Nephrology Unit during a 1 year period were evaluated for RAAS blocker use. Two hundred and seventy-nine patients (166 male, 113 female) were analyzed. The mean age of the patients was 56.7 AE 15.2 years, mean serum creatinine was 2.45 AE 1.44 mg/dL, and mean glomerular filtration rate was 33.3 AE 15.1 mL/min. The mean follow-up time was 22.0 AE 21.9 months and the clinical visit number was 4.0 AE 3.5. Angiotensin-converting-enzyme inhibitors or angiotensin receptor blockers were used by 68.8% of all patients and 67.7% of diabetic patients at the time of analysis. In 82.1% of patients, RAAS blockers had either been used earlier or were being used. Hyperkalemia was the principal reason for both not starting and also discontinuing these drugs in patients with CKD. In 37.4% of patients, reasons for not starting RAAS blockers were unclear. This study showed that hyperkalemia is the major barrier against the use of RAAS blockers in patients with CKD. There was, however, a subset of patients who did not receive RAAS blockers even without clear contraindications.

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Patterns of medication use in the RRI-CKD study: focus on medications with cardiovascular effects

Abstract: This study provides an overview of prescription practices in a cohort of CKD patients. Substantial underutilization of certain classes of cardioprotective medications is apparent, and systematic educational efforts in this direction may well prove worthwhile to impact outcomes.

Cited by 106 publications

References 16 publications

Prevalence and management of anemia in pre-dialysis Malaysian patients: A hospital-based study

Prevalence and management of anemia in pre-dialysis Malaysian patients: A hospital-based study

Risks of Subsequent Hospitalization and Death in Patients with Kidney Disease

Major Barriers against Renin–Angiotensin–Aldosterone System Blocker Use in Chronic Kidney Disease Stages 3–5 in Clinical Practice: A Safety Concern?

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