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The burden of nephrotoxic drug prescriptions in patients with chronic kidney disease: a retrospective population-based study in Southern Italy.

Ingrasciotta Y, Sultana J, Giorgianni F, Caputi AP, Arcoraci V, Tari DU, Linguiti C, Perrotta M, Nucita A, Pellegrini F, Fontana A, Cavagna L, Santoro D, Trifirò G - PLoS ONE (2014)

Bottom Line: A large proportion of CKD patients (35.6%) were treated with NSAIDs for periods exceeding 90 days.Contraindicated nephrotoxic drugs were used commonly in CKD, with nimesulide (16.6%) and diclofenac (11.0%) being most frequently used.Contraindicated nephrotoxic drugs were highly prescribed in CKD patients from a general population of Southern Italy.

View Article: PubMed Central - PubMed

Affiliation: Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy.

ABSTRACT

Background: The use of nephrotoxic drugs can further worsening renal function in chronic kidney disease (CKD) patients. It is therefore imperative to explore prescribing practices that can negatively affect CKD patients.

Aim: To analyze the use of nephrotoxic drugs in CKD patients in a general population of Southern Italy during the years 2006-2011.

Methods: The general practice "Arianna" database contains data from 158,510 persons, registered with 123 general practitioners (GPs) of Caserta. CKD patients were identified searching: CKD-related ICD-9 CM codes among causes of hospitalization; CKD-relevant procedures undergone in hospital (e.g. dialysis); drug prescriptions issued for a CKD-related indication. A list of nephrotoxic drugs was compiled and validated by pharmacologists and nephrologists. The summary of product characteristics was used to classify drugs as 'contraindicated' or 'to be used with caution' in renal diseases. Frequency of nephrotoxic drug use, overall, by drug class and single compounds, by GPs within one year prior or after first CKD diagnosis and within one year after dialysis entry was calculated.

Results: Overall, 1,989 CKD patients and 112 dialysed patients were identified. Among CKD patients, 49.8% and 45.2% received at least one prescription for a contraindicated nephrotoxic drug within one year prior or after first CKD diagnosis, respectively. In detail, 1,119 CKD patients (56.3%) had at least one nonsteroidal anti-inflammatory drugs (NSAIDs) prescription between CKD diagnosis and end of follow-up. A large proportion of CKD patients (35.6%) were treated with NSAIDs for periods exceeding 90 days. Contraindicated nephrotoxic drugs were used commonly in CKD, with nimesulide (16.6%) and diclofenac (11.0%) being most frequently used.

Conclusions: Contraindicated nephrotoxic drugs were highly prescribed in CKD patients from a general population of Southern Italy. CKD diagnosis did not seem to reduce significantly the prescription of nephrotoxic drugs, which may increase the risk of preventable renal function deterioration.

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Flow chart of CKD patients included in the study.
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pone-0089072-g001: Flow chart of CKD patients included in the study.

Mentions: A cohort of 2,128 patients with both prevalent and incident CKD was identified during the years 2006–2011. Of these, we included in the analysis 1,989 newly diagnosed CKD patients (1.25% of the total general population). Among incident CKD patients, 112 (5.6%) underwent dialysis during the observation period (Figure 1). The mean follow-up time of CKD patients between the index date and end of follow-up was 2.6 years. Figure 2 shows that 49.8% of incident CKD patients (N = 1,989) received at least one prescription for a contraindicated nephrotoxic drug within one year prior to the first CKD diagnosis with only a slight decrease of this proportion (45.2%) within one year after CKD diagnosis. A slightly lower proportion (33.9%) of CKD patients treated with contraindicated drugs was observed within one year after dialysis entry.


The burden of nephrotoxic drug prescriptions in patients with chronic kidney disease: a retrospective population-based study in Southern Italy.

Ingrasciotta Y, Sultana J, Giorgianni F, Caputi AP, Arcoraci V, Tari DU, Linguiti C, Perrotta M, Nucita A, Pellegrini F, Fontana A, Cavagna L, Santoro D, Trifirò G - PLoS ONE (2014)

Flow chart of CKD patients included in the study.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3928406&req=5

pone-0089072-g001: Flow chart of CKD patients included in the study.
Mentions: A cohort of 2,128 patients with both prevalent and incident CKD was identified during the years 2006–2011. Of these, we included in the analysis 1,989 newly diagnosed CKD patients (1.25% of the total general population). Among incident CKD patients, 112 (5.6%) underwent dialysis during the observation period (Figure 1). The mean follow-up time of CKD patients between the index date and end of follow-up was 2.6 years. Figure 2 shows that 49.8% of incident CKD patients (N = 1,989) received at least one prescription for a contraindicated nephrotoxic drug within one year prior to the first CKD diagnosis with only a slight decrease of this proportion (45.2%) within one year after CKD diagnosis. A slightly lower proportion (33.9%) of CKD patients treated with contraindicated drugs was observed within one year after dialysis entry.

Bottom Line: A large proportion of CKD patients (35.6%) were treated with NSAIDs for periods exceeding 90 days.Contraindicated nephrotoxic drugs were used commonly in CKD, with nimesulide (16.6%) and diclofenac (11.0%) being most frequently used.Contraindicated nephrotoxic drugs were highly prescribed in CKD patients from a general population of Southern Italy.

View Article: PubMed Central - PubMed

Affiliation: Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy.

ABSTRACT

Background: The use of nephrotoxic drugs can further worsening renal function in chronic kidney disease (CKD) patients. It is therefore imperative to explore prescribing practices that can negatively affect CKD patients.

Aim: To analyze the use of nephrotoxic drugs in CKD patients in a general population of Southern Italy during the years 2006-2011.

Methods: The general practice "Arianna" database contains data from 158,510 persons, registered with 123 general practitioners (GPs) of Caserta. CKD patients were identified searching: CKD-related ICD-9 CM codes among causes of hospitalization; CKD-relevant procedures undergone in hospital (e.g. dialysis); drug prescriptions issued for a CKD-related indication. A list of nephrotoxic drugs was compiled and validated by pharmacologists and nephrologists. The summary of product characteristics was used to classify drugs as 'contraindicated' or 'to be used with caution' in renal diseases. Frequency of nephrotoxic drug use, overall, by drug class and single compounds, by GPs within one year prior or after first CKD diagnosis and within one year after dialysis entry was calculated.

Results: Overall, 1,989 CKD patients and 112 dialysed patients were identified. Among CKD patients, 49.8% and 45.2% received at least one prescription for a contraindicated nephrotoxic drug within one year prior or after first CKD diagnosis, respectively. In detail, 1,119 CKD patients (56.3%) had at least one nonsteroidal anti-inflammatory drugs (NSAIDs) prescription between CKD diagnosis and end of follow-up. A large proportion of CKD patients (35.6%) were treated with NSAIDs for periods exceeding 90 days. Contraindicated nephrotoxic drugs were used commonly in CKD, with nimesulide (16.6%) and diclofenac (11.0%) being most frequently used.

Conclusions: Contraindicated nephrotoxic drugs were highly prescribed in CKD patients from a general population of Southern Italy. CKD diagnosis did not seem to reduce significantly the prescription of nephrotoxic drugs, which may increase the risk of preventable renal function deterioration.

Show MeSH
Related in: MedlinePlus