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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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Proportion of CKD patients (N = 1,989) who received ≥ 1 prescription of CND, stratified by classes.Proportion of CKD patients (N = 1,989) who received at least one prescription of contraindicated nephrotoxic drugs, stratified by drug classes, within one year prior or after first CKD diagnosis, and within one year after the entry in dialysis (N = 112) within one year prior or after first CKD diagnosis, and within one year after the entry in dialysis (N = 112). Others: zoledronate, lithium, antineoplastic agents (methotrexate, interferon alfa-2B), gold preparations (auranofin), hydrochlorothiazide. Low dosage acetylsalicylic acid was not included among NSAIDs, but it was analysed in Figure 5, separately. CND: contraindicated nephrotoxic drug.
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pone-0089072-g004: Proportion of CKD patients (N = 1,989) who received ≥ 1 prescription of CND, stratified by classes.Proportion of CKD patients (N = 1,989) who received at least one prescription of contraindicated nephrotoxic drugs, stratified by drug classes, within one year prior or after first CKD diagnosis, and within one year after the entry in dialysis (N = 112) within one year prior or after first CKD diagnosis, and within one year after the entry in dialysis (N = 112). Others: zoledronate, lithium, antineoplastic agents (methotrexate, interferon alfa-2B), gold preparations (auranofin), hydrochlorothiazide. Low dosage acetylsalicylic acid was not included among NSAIDs, but it was analysed in Figure 5, separately. CND: contraindicated nephrotoxic drug.

Mentions: Looking at individual drug classes, NSAIDs were the most commonly prescribed contraindicated nephrotoxic drugs to CKD patients during the study period, with a small decrease in the use from one year prior to one year after first CKD diagnosis, and much larger decrease after dialysis entry (47.3% vs. 42.0% vs. 29.5%) (Figure 4). The opposite trend was observed for the use of aminoglycosides (1.8% vs. 2.5% vs. 5.4%), which were in general much less prescribed as compared to NSAIDs (Figure 4). Among NSAIDs used in CKD patients, nimesulide, diclofenac and ibuprofen were the most frequently prescribed compounds, which all showed a small reduction in the use within the first year after CKD diagnosis, as compared to the previous year (Figure 5). A very large proportion of CKD patients received low dosage acetylsalicylic acid and this proportion was even higher after CKD diagnosis (43.5% vs. 41.4%). Overall, 1,119 CKD patients (56.3%) had at least one prescription of any NSAID between the index date and the end of follow-up. Of these, more than one third (35.6%) were treated with NSAIDs for periods exceeding 90 days and almost 16.5% for more than 6 months.


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)

Proportion of CKD patients (N = 1,989) who received ≥ 1 prescription of CND, stratified by classes.Proportion of CKD patients (N = 1,989) who received at least one prescription of contraindicated nephrotoxic drugs, stratified by drug classes, within one year prior or after first CKD diagnosis, and within one year after the entry in dialysis (N = 112) within one year prior or after first CKD diagnosis, and within one year after the entry in dialysis (N = 112). Others: zoledronate, lithium, antineoplastic agents (methotrexate, interferon alfa-2B), gold preparations (auranofin), hydrochlorothiazide. Low dosage acetylsalicylic acid was not included among NSAIDs, but it was analysed in Figure 5, separately. CND: contraindicated nephrotoxic drug.
© Copyright Policy
Related In: Results  -  Collection

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

pone-0089072-g004: Proportion of CKD patients (N = 1,989) who received ≥ 1 prescription of CND, stratified by classes.Proportion of CKD patients (N = 1,989) who received at least one prescription of contraindicated nephrotoxic drugs, stratified by drug classes, within one year prior or after first CKD diagnosis, and within one year after the entry in dialysis (N = 112) within one year prior or after first CKD diagnosis, and within one year after the entry in dialysis (N = 112). Others: zoledronate, lithium, antineoplastic agents (methotrexate, interferon alfa-2B), gold preparations (auranofin), hydrochlorothiazide. Low dosage acetylsalicylic acid was not included among NSAIDs, but it was analysed in Figure 5, separately. CND: contraindicated nephrotoxic drug.
Mentions: Looking at individual drug classes, NSAIDs were the most commonly prescribed contraindicated nephrotoxic drugs to CKD patients during the study period, with a small decrease in the use from one year prior to one year after first CKD diagnosis, and much larger decrease after dialysis entry (47.3% vs. 42.0% vs. 29.5%) (Figure 4). The opposite trend was observed for the use of aminoglycosides (1.8% vs. 2.5% vs. 5.4%), which were in general much less prescribed as compared to NSAIDs (Figure 4). Among NSAIDs used in CKD patients, nimesulide, diclofenac and ibuprofen were the most frequently prescribed compounds, which all showed a small reduction in the use within the first year after CKD diagnosis, as compared to the previous year (Figure 5). A very large proportion of CKD patients received low dosage acetylsalicylic acid and this proportion was even higher after CKD diagnosis (43.5% vs. 41.4%). Overall, 1,119 CKD patients (56.3%) had at least one prescription of any NSAID between the index date and the end of follow-up. Of these, more than one third (35.6%) were treated with NSAIDs for periods exceeding 90 days and almost 16.5% for more than 6 months.

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