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Inappropriate prescribing in chronic kidney disease: A systematic review of prevalence, associated clinical outcomes and impact of interventions

Tesfaye, WH, Castelino, RL, Wimmer, BC ORCID: 0000-0003-3166-7126 and Zaidi, STR ORCID: 0000-0002-2031-1055 2017 , 'Inappropriate prescribing in chronic kidney disease: A systematic review of prevalence, associated clinical outcomes and impact of interventions' , International journal of clinical practice, vol. 71, no. 7 , pp. 1-16 , doi: 10.1111/ijcp.12960.

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Abstract

Introduction: Adjusting doses of renally cleared medications and/or avoidance of nephrotoxicmedications are standard clinical practices in chronic kidney disease (CKD),albeit the prevalence of inappropriate prescribing (IP) in these patients remains high.Therefore, this work sought to systematically review the prevalence of IP and comparethe relative effectiveness of available interventions in reducing IP in CKD.Methods: Studies were identified searching PubMed/Medline, EMBASE, CochraneLibrary, IPA, Web of Science, Ovid/Medline, CINAHL, and PsychINFO databases.Studies defining CKD based on laboratory markers and quantifying prevalence of IPwere included.Results: Forty-nine studies from 23 countries met the inclusion criteria. An IP prevalenceof 9.4%-81.1% and 13%-80.50% was reported in hospital and ambulatory settings,respectively; whereas, in long-term care facilities the prevalence ranged between16% and 37.9%. Unsurprisingly, IP was associated with adverse drug events like increasedhospital stay (Mean [SD] of 4.5 [4.8] vs 4.3 [4.5]) and high risk of mortality[40%]. Twenty-one studies reported the impact of interventions on IP; manual andcomputerised alerts were the main forms of interventions (n=19). The most significantreduction in IP was observed when physicians received immediate concurrent feedbackfrom a clinical pharmacist (PConclusion: IP has led to poor patient outcomes. Although pharmacist-based andcomputer-aided approaches have shown promising results, there is still room forimprovement. Future studies should focus on developing a multifaceted interventionto address the widespread prevalence of IP and associated clinical outcomes in CKDpatients.

Item Type: Article
Authors/Creators:Tesfaye, WH and Castelino, RL and Wimmer, BC and Zaidi, STR
Keywords: systematic review, chronic kidney disease, inappropriate prescribing, interventions
Journal or Publication Title: International journal of clinical practice
Publisher: Blackwell Publishing Ltd
ISSN: 1368-5031
DOI / ID Number: 10.1111/ijcp.12960
Copyright Information:

© 2017 John Wiley & Sons Ltd

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