Prevalence and Management of Drug-Related Problems in Chronic Kidney Disease Patients by Severity Level: A Subanalysis of a Cluster Randomized Controlled Trial in Community Pharmacies

Quintana-Bárcena, Patricia; Lord, Anne; Lizotte, Annie; Berbiche, Djamal; Lalonde, Lyne

doi:10.18553/jmcp.2018.24.2.173

Cited by 19 publications

(44 citation statements)

References 38 publications

(36 reference statements)

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“…These 556 patients together took 5196 separate medications, mainly orally (89.0%). The median number of drugs per day per patient was 9 [7][8][9][10][11], split into 3 tertile groups: 6 [2-7]; 9 [8][9][10]; and 12 [11][12][13][14][15][16][17][18][19][20][21][22][23][24]. The characteristics of the overall population according to tertile of daily drugs are presented in the Table 1.…”

Section: Study Populationmentioning

confidence: 99%

“…Most of these studies are from the United States of America and describe various medication-related issues or inappropriate medications in patients with stage 3-4 CKD or on dialysis [2,6]. Few studies had previously described prescription patterns and inappropriate medication in nondialysis elderly patients with advanced CKD [1,12]. No study focused only on non-dialysis elderly patients with eGFR< 20 ml/min/1.73.…”

Section: Introductionmentioning

confidence: 99%

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Medication burden and inappropriate prescription risk among elderly with advanced chronic kidney disease

et al. 2020

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Background: Elderly patients with chronic kidney disease (CKD) frequently present comorbidities that put them at risk of polypharmacy and medication-related problems. This study aims to describe the overall medication profile of patients aged ≥75 years with advanced CKD from a multicenter French study and specifically the renally (RIMs) and potentially inappropriate-for-the-elderly medications (PIMs) that they take.Methods: This is a cross-sectional analysis of medication profiles of individuals aged ≥75 years with eGFR < 20 ml/min/1.73 m2 followed by a nephrologist, who collected their active prescriptions at the study inclusion visit. Medication profiles were first analyzed according to route of administration, therapeutic classification. Second, patients were classified according to their risk of potential medication-related problems, based on whether the prescription was a RIM or a PIM. RIMs and PIMs have been defined according to renal appropriateness guidelines and to Beer's criteria in the elderly. RIMs were subclassified by 4 types of category: (a) contraindication; (b) dose modification is recommended based on creatinine clearance (CrCl); (c) dose modification based on CrCl is not recommended but a maximum daily dose is mentioned, (d) no specific recommendations based on CrCl: "use with caution", "avoid in severe impairment", "careful monitoring of dose is required" "reduce the dose". Results:We collected 5196 individual medication prescriptions for 556 patients, for a median of 9 daily medications [7][8][9][10][11]. Antihypertensive agents, antithrombotics, and antianemics were the classes most frequently prescribed. Moreover, 77.0% of patients had at least 1 medication classified as a RIM. They accounted 31.3% of the drugs prescribed and 9.25% was contraindicated drugs. At least 1 PIM was taken by 57.6 and 45.5% of patients had at least one medication classified as RIM and PIM. The prescriptions most frequently requiring reassessment due to potential adverse effects were for proton pump inhibitors and allopurinol. The PIMs for which deprescription is especially important in this population are rilmenidine, long-term benzodiazepines, and anticholinergic drugs such as hydroxyzine.(Continued on next page) Conclusion: We showed potential drug-related problems in elderly patients with advanced CKD. Healthcare providers must reassess each medication prescribed for this population, particularly the specific medications identified here.Trial registration: NCT02910908.

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Section: Study Populationmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Medication burden and inappropriate prescription risk among elderly with advanced chronic kidney disease

et al. 2020

View full text Add to dashboard Cite

show abstract

Section: Study Populationmentioning

confidence: 99%

“…Most of these studies are from the United States of America and describe various medication-related issues or inappropriate medications in patients with stage 3-4 CKD or on dialysis (2,6). No Few studies had previously described prescription patterns and inappropriate medication in non-dialysis elderly patients with advanced CKD (1,12). No study focused only on non-dialysis elderly patients with eGFR<20 ml/min/1.73.…”

Section: Introductionmentioning

confidence: 99%

Medication Burden And Inappropriate Prescription Risk Among Elderly With Advanced Chronic Kidney Disease

Roux-Marson

Baranski

Fafin

et al. 2019

Preprint

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Background Elderly patients with chronic kidney disease (CKD) frequently present comorbidities that put them at risk of polypharmacy and medication-related problems. This study aims to describe the overall medication profile of patients aged ≥ 75 years with advanced CKD from a multicenter French study and specifically the renally (RIMs) and potentially inappropriate-for-the-elderly medications (PIMs) that they take. Methods This is a cross-sectional analysis of medication profiles of individuals aged ≥ 75 years with eGFR < 20 ml/min/1.73m2 followed by a nephrologist, who collected their active prescriptions at the study inclusion visit. Medication profiles were first analyzed according to route of administration, therapeutic classification. Second, patients were classified according to their risk of potential medication-related problems, based on whether the prescription was a RIM or a PIM.RIMs and PIMs have been defined according to renal appropriateness guidelines and to Beer's criteria in the elderly. RIMs were subclassified by 4 types of category : (a) contraindication; (b) dose modification is recommended based on creatinine clearance (CrCl); (c) dose modification based on CrCl is not recommended but a maximum daily dose is mentioned, (d) no specific recommendations based on CrCl : "use with caution", "avoid in severe impairment", "careful monitoring of dose is required" "reduce the dose". Results We collected 5196 individual medication prescriptions for 556 patients, for a median of 9 daily medications [7][8][9][10][11]. Antihypertensive agents, antithrombotics, and antianemics were the classes most frequently prescribed. Moreover, 77.0% of patients had at least 1 medication classified as a RIM. They accounted 31.3% of the drugs prescribed and 9.25% was contraindicated drugs. At least 1 PIM was taken by 57.6% and 45.5% of patients had at least one medication classified as RIM and PIM. The prescriptions most frequently requiring reassessment due to potential adverse effects were for proton pump inhibitors and allopurinol. The PIMs for which deprescription is especially important in this population are rilmenidine, long-term benzodiazepines, and anticholinergic drugs such as hydroxyzine. Conclusion We showed potential drug-related problems in elderly patients with advanced CKD. Healthcare providers must reassess each medication prescribed for this population, particularly the specific medications identified here.

show abstract

“…Most of these studies are from the United States of America and describe various medication-related issues or inappropriate medications in patients with stage 3-4 CKD or on dialysis (2,6). Few studies had previously described prescription patterns and inappropriate medication in non-dialysis elderly patients with advanced CKD (1,12). No study focused only on non-dialysis elderly patients with eGFR<20 ml/min/1.73.…”

Section: Introductionmentioning

confidence: 99%

Medication Burden And Inappropriate Prescription Risk Among Elderly With Advanced Chronic Kidney Disease

Roux-Marson

Baranski

Fafin

et al. 2020

Preprint

View full text Add to dashboard Cite

Background Elderly patients with chronic kidney disease (CKD) frequently present comorbidities that put them at risk of polypharmacy and medication-related problems. This study aims to describe the overall medication profile of patients aged ≥ 75 years with advanced CKD from a multicenter French study and specifically the renally (RIMs) and potentially inappropriate-for-the-elderly medications (PIMs) that they take. Methods This is a cross-sectional analysis of medication profiles of individuals aged ≥ 75 years with eGFR < 20 ml/min/1.73m2 followed by a nephrologist, who collected their active prescriptions at the study inclusion visit. Medication profiles were first analyzed according to route of administration, therapeutic classification. Second, patients were classified according to their risk of potential medication-related problems, based on whether the prescription was a RIM or a PIM. RIMs and PIMs have been defined according to renal appropriateness guidelines and to Beer’s criteria in the elderly. RIMs were subclassified by 4 types of category : (a) contraindication; (b) dose modification is recommended based on creatinine clearance (CrCl); (c) dose modification based on CrCl is not recommended but a maximum daily dose is mentioned, (d) no specific recommendations based on CrCl : “use with caution”, “avoid in severe impairment”, “careful monitoring of dose is required” “reduce the dose”. Results We collected 5196 individual medication prescriptions for 556 patients, for a median of 9 daily medications [7-11]. Antihypertensive agents, antithrombotics, and antianemics were the classes most frequently prescribed. Moreover, 77.0% of patients had at least 1 medication classified as a RIM. They accounted 31.3% of the drugs prescribed and 9.25% was contraindicated drugs. At least 1 PIM was taken by 57.6% and 45.5% of patients had at least one medication classified as RIM and PIM. The prescriptions most frequently requiring reassessment due to potential adverse effects were for proton pump inhibitors and allopurinol. The PIMs for which deprescription is especially important in this population are rilmenidine, long-term benzodiazepines, and anticholinergic drugs such as hydroxyzine. Conclusion We showed potential drug-related problems in elderly patients with advanced CKD. Healthcare providers must reassess each medication prescribed for this population, particularly the specific medications identified here.

show abstract

Prevalence and Management of Drug-Related Problems in Chronic Kidney Disease Patients by Severity Level: A Subanalysis of a Cluster Randomized Controlled Trial in Community Pharmacies

Cited by 19 publications

References 38 publications

Medication burden and inappropriate prescription risk among elderly with advanced chronic kidney disease

Medication burden and inappropriate prescription risk among elderly with advanced chronic kidney disease

Medication Burden And Inappropriate Prescription Risk Among Elderly With Advanced Chronic Kidney Disease

Medication Burden And Inappropriate Prescription Risk Among Elderly With Advanced Chronic Kidney Disease

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