Titre :

Evaluation of the adequacy of drug prescriptions in patients with chronic kidney disease: results from the CKD‐REIN cohort

Auteur(s) :

Laville, Solène M. [Auteur]
Metzger, Marie [Auteur]
Stengel, Bénédicte [Auteur]
Jacquelinet, Christian [Auteur]
Combe, Christian [Auteur]
Fouque, Denis [Auteur]
Laville, Maurice [Auteur]
Frimat, Luc [Auteur]
Ayav, Carole [Auteur]
Speyer, Elodie [Auteur]
Robinson, Bruce M. [Auteur]
Massy, Ziad A. [Auteur]
Liabeuf, Sophie [Auteur]
Glowacki, Francois [Auteur]
Cancer Heterogeneity, Plasticity and Resistance to Therapies (CANTHER) - UMR 9020 - UMR 1277

Titre de la revue :

British Journal of Clinical Pharmacology

Nom court de la revue :

Brit J Clinical Pharma

Numéro :

84

Pagination :

2811-2823

Éditeur :

Wiley

Date de publication :

2018-09-24

Résumé en anglais : [en]

AbstractAimsDrug prescription is difficult to manage in patients with chronic kidney disease (CKD). We assessed the prevalence and determinants of inappropriate drug prescriptions (whether contraindications or inappropriately ...
Lire la suite >AbstractAimsDrug prescription is difficult to manage in patients with chronic kidney disease (CKD). We assessed the prevalence and determinants of inappropriate drug prescriptions (whether contraindications or inappropriately high doses) with regard to kidney function in patients with CKD under nephrology care. We also assessed the impact of the equation used to estimate GFR on the prevalence estimates.MethodsThe CKD‐REIN cohort includes 3033 outpatients with CKD (eGFR between 15 and 60 ml min−1 1.73 m−2). We examined the daily doses of pharmacological agents prescribed at study entry. Inappropriate prescription was defined as the reported prescription of either a contraindicated drug or an indicated drug at an inappropriately high dose level with regard to the patient's GFR, as estimated with the CKD‐EPI equation, the de‐indexed CKD‐EPI equation, or the Cockcroft–Gault (CG) equation. Multivariate logistic regression was used to assess the determinants of inappropriate prescription risk.ResultsAt baseline, patients' median [interquartile range] number of drugs prescribed per patient was 8 [5–10]. Half of the patients had been prescribed at least one inappropriate drug. Anti‐gout, cardiovascular agents and antidiabetic agents accounted for most of the inappropriate prescriptions. The percentage of inappropriate prescriptions varied from one GFR equation to another: 52% when using the CKD‐EPI equation, 47% when using the de‐indexed CKD‐EPI equation and 41% with the CG equation. A multiple logistic regression analysis showed significantly higher odds ratios [95% confidence interval] for inappropriate prescriptions in male patients (1.28 [1.07; 1.53]), patients with diabetes (1.34 [1.06; 1.70]), those with a high BMI (1.58 [1.25; 1.99]), and those with a low GFR (10.2 [6.02; 17.3]). The risk of having at least one inappropriate prescription increased with the number of drugs per patient (P for trend < 0.0001) and therefore the odds ratio was 5.88 [4.17; 8.28] for those who received at least 11 prescribed medications compared to those who received fewer than 5.ConclusionOur results emphasize the complexity of drug management for CKD patients, for whom inappropriate prescription appears to be common.Lire moins >

Audience :

Internationale

Vulgarisation :

Non

Établissement(s) :

Université de Lille
CHU Lille
Institut Pasteur de Lille

Collections :

• IMPact de l'Environnement Chimique sur la Santé humaine (IMPECS) - ULR 4483

Date de dépôt :

2024-04-18T08:33:03Z
2024-05-10T13:59:36Z
2024-05-10T14:07:42Z