Potentially inappropriate prescribing is common in patients with chronic kidney disease (CKD) in primary care, according to a new retrospective Scottish population-based analysis.
High-risk prescribing in CKD contributes to adverse drug reactions and drug-related acute kidney injury (AKI)—people with CKD have the poorest health outcomes after drug-related AKI, specifically being most likely to have additional loss of kidney function, require dialysis and die.
This cross-sectional study, published in the British Journal of General Practice, compared prescribing patterns in the primary care setting of people with CKD in two health boards in Scotland.
CKD was defined as the estimated glomerular filtration rate of ≤60 mL/min/1.73 m2 for more than three months.
Drugs were organised by the British National Formulary advice on contraindicated drugs: ‘avoid’; potentially high-risk (PHR) drugs: ‘avoid if possible’; and dose-inappropriate (DI) drugs: ‘dose exceeded recommended maximums’.
The total study cohort was 28,489 adults, of whom 70.1 per cent had CKD stage IIIa, 22.4 per cent CKD stage IIIb, 5.9 per cent CKD stage IV and 1.5 per cent CKD stage V.
A total of 3.9 per cent (95% CI, 3.7%-4.1%) of people with CKD stages IIIa-V were prescribed one or more contraindicated drugs, 24.3 per cent (95% CI, 23.8%-24.8%) one or more PHR drugs and 15.2 per cent (95% CI, 14.8%-15.6%) one or more DI drugs.
Contraindicated drugs differed in prevalence by CKD stage and were most commonly prescribed in CKD stage IV, with a prevalence of 36.0 per cent (95% CI, 33.7%-38.2%).
PHR drugs were commonly prescribed in all CKD stages, ranging from 19.4 per cent (95% CI, 17.6%-21.3%) in CKD stage IV to 25.1 per cent (95% CI, 24.5%-25.7%) in CKD stage IIIa.
DI drugs were most commonly prescribed in CKD stage IV (26.4%; 95% CI, 24.3%-28.6%).
Existing recommendations for prescribing in renal impairment are often non-specific and relatively unhelpful to clinicians, the study authors noted. “Development and evaluation of interventions to improve prescribing safety in this high-risk population are needed.”
