Kidney Disease Management in the Hospital Setting: A Focus on Inappropriate Drug Prescriptions in Older Patients

Frontiers in Pharmacology

卷:12

on behalf of the REPOSI investigators¹  Vincenzo Arcoraci²  Giovanni Squadrito²  Maria Antonietta Barbieri²  Michelangelo Rottura²  Salvatore Corrao³  Alessandro Nobili⁴  Christiano Argano⁵  Giuseppe Natoli⁵  Francesco Squadrito⁶ 

[1] ;

[2] Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy;

[3] Department of Internal Medicine, National Relevance and High Specialization Hospital Trust ARNAS Civico, Di Cristina, Benfratelli, Palermo, Italy;

[4] Department of Neuroscience, IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy;

[5] Dipartimento di Promozione Della Salute, Materno Infantile, Medicina Interna e Specialistica di Eccellenza “G. D’Alessandro”, PROMISE, University of Palermo, Palermo, Italy;

[6] SunNutraPharma, Academic Spin-Off Company of the University of Messina, Messina, Italy;

关键词: chronic kidney disease;    appropriateness of prescriptions;    prescribing patterns;    real-world data;    hospital setting;    older patients;   

DOI  :  10.3389/fphar.2021.749711

来源: DOAJ

【 摘 要 】

Aging with multimorbidity and polytherapy are the most significant factors that could led to inappropriate prescribing of contraindicated medications in patients with chronic kidney disease (CKD). The aim of this study was to evaluate the prescriptions of contraindicated drugs in older adults in CKD and to identify their associated factors in a hospital context. An observational retrospective study was carried out considering all patients ≥65 years with at least one serum creatinine value recorded into the REPOSI register into 2010–2016 period. The estimated glomerular filtration rate (eGFR) was applied to identify CKD. A descriptive analysis was performed to compare demographic and clinical characteristics; logistic regression models were used to estimate factors of inappropriate and percentage changes of drug use during hospitalization. A total of 4,713 hospitalized patients were recorded, of which 49.8% had an eGFR <60 ml/min/1.73 m2; the 21.9% were in treatment with at least one inappropriate drug at the time of hospital admission with a decrease of 3.0% at discharge (p = 0.010). The probability of using at least one contraindicated drug was significantly higher in patients treated with more several drugs (OR 1.21, 95% CI 1.16–1.25, p <0.001) and with CKD end-stages (G4: 16.90, 11.38–25.12, p < 0.001; G5: 19.38, 11.51–32.64, p < 0.001). Low-dose acetylsalicylic acid was the contraindicated drug mainly used at the time of admission, reducing 1.2% at discharge. An overall increase in therapeutic appropriateness in hospitalized older patients with CKD was observed, despite a small percentage of therapeutic inappropriateness at discharge that underlines the need for a closer collaboration with the pharmacologist to improve the drug management.

【 授权许可】

Unknown