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Quality use of medicines in patients with chronic kidney disease


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Castelino, RL, Saunder, T, Kitsos, A ORCID: 0000-0003-4319-1559, Peterson, GM ORCID: 0000-0002-6764-3882, Jose, M ORCID: 0000-0002-9589-0071, Wimmer, B ORCID: 0000-0003-3166-7126, Khanam, M ORCID: 0000-0002-2103-6462, Bezabhe, W ORCID: 0000-0002-3028-6949, Stankovich, J ORCID: 0000-0001-9344-7749 and Radford, J ORCID: 0000-0002-5751-0488 2020 , 'Quality use of medicines in patients with chronic kidney disease' , BMC Nephrology, vol. 21 , pp. 1-9 , doi: 10.1186/s12882-020-01862-1.

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Background: Chronic kidney disease (CKD) affects drug elimination and patients with CKD require appropriateadjustment of renally cleared medications to ensure safe and effective pharmacotherapy. The main objective of thisstudy was to determine the extent of potentially inappropriate prescribing (PIP; defined as the use of acontraindicated medication or inappropriately high dose according to the kidney function) of renally-clearedmedications commonly prescribed in Australian primary care, based on two measures of kidney function. Asecondary aim was to assess agreement between the two measures.Methods: Retrospective analysis of routinely collected de-identified Australian general practice patient data (NPSMedicineWise MedicineInsight from January 1, 2013, to June 1, 2016; collected from 329 general practices). Alladults (aged ≥18 years) with CKD presenting to general practices across Australia were included in the analysis.Patients were considered to have CKD if they had two or more estimated glomerular filtration rate (eGFR) recordedvalues 2, and/or two urinary albumin/creatinine ratios ≥3.5 mg/mmol in females (≥2.5 mg/mmolin males) at least 90 days apart. PIP was assessed for 49 commonly prescribed medications using the CockcroftGault (CG) equation/eGFR as per the instructions in the Australian Medicines Handbook.Results: A total of 48,731 patients met the Kidney Health Australia (KHA) definition for CKD and had prescriptionsrecorded within 90 days of measuring serum creatinine (SCr)/estimated glomerular filtration rate (eGFR). Overall, 28,729 patients were prescribed one or more of the 49 medications of interest. Approximately 35% (n = 9926) of thesepatients had at least one PIP based on either the Cockcroft-Gault (CG) equation or eGFR (CKD-EPI; CKDEpidemiology Collaboration Equation). There was good agreement between CG and eGFR while determining theappropriateness of medications, with approximately 97% of the medications classified as appropriate by eGFR alsobeing considered appropriate by the CG equation.Conclusion: This study highlights that PIP commonly occurs in primary care patients with CKD and the need forfurther research to understand why and how this can be minimised. The findings also show that the eGFR providesclinicians a potential alternative to the CG formula when estimating kidney function to guide drug appropriatenessand dosing.

Item Type: Article
Authors/Creators:Castelino, RL and Saunder, T and Kitsos, A and Peterson, GM and Jose, M and Wimmer, B and Khanam, M and Bezabhe, W and Stankovich, J and Radford, J
Keywords: chronic kidney disease, prescribing, general practice, e-health records
Journal or Publication Title: BMC Nephrology
Publisher: BioMed Central Ltd.
ISSN: 1471-2369
DOI / ID Number: 10.1186/s12882-020-01862-1
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Copyright 2020 The Authors. Licensed under Creative Commons Attribution 4.0 International (CC BY 4.0)

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