Use of nephrotoxic medications in adults with chronic kidney disease in Swedish and US routine care

Abstract

Background To characterize use of nephrotoxic medications in patients with CKD Stage G3-5 in routine care. Methods Cohorts of adults with confirmed CKD G3-5 undergoing routine care during January 1, 2016 through December 31, 2018 in two health systems (Stockholm CREAtinine Measurements [SCREAM], Stockholm, Sweden [N = 57,880]; and Geisinger, Pennsylvania, U.S. [N = 16,255]). We evaluated the proportion of patients receiving nephrotoxic medications within one year overall and by baseline kidney function, ranked main contributors, and examined the association between receipt of nephrotoxic medication and age, sex, CKD G-stages, comorbidities and provider awareness of the patient's CKD using multivariable logistic regression. Results During a one-year period, 20% (SCREAM) and 17% (Geisinger) of patients with CKD received at least one nephrotoxic medication. Among the top nephrotoxic medications identified in both cohorts were NSAIDs (given to 11% and 9% of patients in SCREAM and Geisinger, respectively), antivirals (2.5% and 2.0%) and immunosuppressants (2.7% and 1.5%). Bisphosphonate use was common in SCREAM (3.3%), and fenofibrates in Geisinger (3.6%). Patients with age < 65 years, women, or with CKD G3 were at higher risk of receiving nephrotoxic medications in both cohorts. Notably, provider awareness of a patient's CKD was associated with lower odds of nephrotoxic medication use (OR, 0.85; 95% CI, 0.80–0.90 in SCREAM and OR, 0.80; 95% CI, 0.72–0.89 in Geisinger). Conclusions One in five patients with CKD received nephrotoxic medications in two distinct health systems. Strategies to increase physician's awareness of patients’ CKD and knowledge of drug nephrotoxicity may reduce prescribing nephrotoxic medications and prevent iatrogenic kidney injury.

The Stockholm CREAtinine Measurements (SCREAM) project: Fostering improvements in chronic kidney disease care

“…They observed that 9% of older adults with CKD stage 3 and 38% with CKD stage 4 received at least one contraindicated drug. Bosi et al [51] expanded this work by evaluating the risk of nephrotoxic drug use by persons with eGFR <60 ml/min/1.73 m 2 during the more recent period 2016-2018. The situation proved to be similar or worse; during a 1-year period, 20% of patients with CKD received at least one potentially inappropriate nephrotoxic medication.…”

CKD: The burden of disease invisible to research funders

“…3 ). 16 , 17 Thus, only 23% of participants in the CKD cohort had been diagnosed by their physicians as having CKD while the number should be 100%.

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“…Note that among persons included in the cohort because researchers retrospectively diagnosed CKD, the physician in charge diagnosed cancer or diabetes more commonly than CKD. Data from 16 , figure from 17 . …”

Ageing meets kidney disease

“…Indeed, GFR and UACR thresholds to define CKD were chosen because, when persisting for ˃3 months, they are associated with an increased risk of adverse outcomes including acute kidney injury (AKI), progression to kidney failure requiring kidney replacement therapy, and all-cause mortality. Despite the clear implications of a CKD diagnosis for health, and clear-cut diagnostic criteria, CKD remains an unrecognized condition, especially in older adults [ 5 ]. Moreover, recognition of CKD is important for adequate drug prescription.…”