Expert Opinion on Drug Safety, Journal Year: 2024, Volume and Issue: 23(4), P. 457 - 467
Published: Feb. 8, 2024
Background The study aimed to evaluate the agreement of prescribed drug dosages with renal dosing recommendations and describe adverse events (ADEs) contributing hospital admissions patients chronic kidney disease (CKD).
Language: Английский
Frontiers in Public Health, Journal Year: 2023, Volume and Issue: 11
Published: March 23, 2023
Polypharmacy might contribute to a range of adverse outcomes, which could get worse in the elderly with chronic kidney disease (CKD). Evidence on polypharmacy, CKD, and mortality is scarce. We aimed investigate prospective association between CKD all-cause cause-specific adults aged ≥65 years.A total 13,513 from National Health Nutrition Examination Surveys were included, following up 1999 2018 until December 31, 2019. The simultaneous use ≥5 medications by one individual was defined as polypharmacy. Survey-weighted Cox proportional hazard models used estimate ratio (HRs) for all-cause, cardiovascular diseases (CVD), cancer after adjusting potential confounding factors.Among we identified 3,825 deaths (1,325 CVD 714 cancer) during median follow-up 7.7 years. Participants polypharmacy had 27% (HR = 1.27 [1.15, 1.39]) 39% 1.39 [1.19, 1.62]) higher risk mortality, respectively, but not mortality. Compared no corresponding HRs (95%CIs) 1.04 (0.96, 1.14) those 1.24 (1.11, 1.39) 1.34 (1.21, 1.49) both CKD. A similar pattern detected mortality.Polypharmacy associated elevated risks among patients. More evidence-based approaches should be promoted appropriate deprescribing older
Language: Английский
Citations
10
Clinical Kidney Journal, Journal Year: 2024, Volume and Issue: 17(2)
Published: Jan. 19, 2024
ABSTRACT Background Many non-modifiable factors are associated with poorer health-related quality of life (HRQoL) experienced by people chronic kidney disease (CKD). We hypothesize that potentially modifiable for poor HRQoL can be identified among CKD patients, providing potential targets intervention. Method The National Unified Renal Translational Research Enterprise Chronic Kidney Disease (NURTuRE-CKD) cohort study recruited 2996 participants from nephrology centres all stages non-dialysis-dependent CKD. Baseline data collection sociodemographic, anthropometric, biochemical and clinical information, including Integrated Palliative care Outcome Scale renal, Hospital Anxiety Depression score (HADS) the 5-level EuroQol-5D (EQ-5D-5L) as measure, took place between 2017 2019. EQ-5D-5L dimensions (mobility, self-care, usual activities, pain/discomfort, anxiety/depression) were mapped to an EQ-5D-3L value set derive index value. Multivariable mixed effects regression models, adjusted known affecting recruitment region a random effect, fit assess (linear) within each dimension (logistic). Results Among 2958/2996 (98.7%) complete EQ-5D data, 2201 (74.4%) reported problems in at least one dimension. linear independent associations (EQ-5D-3L value) obesity (body mass ≥30.0 kg/m2, β −0.037, 95% CI −0.058 −0.016, P = .001), HADS depression ≥8 (β −0.159, −0.182 −0.137, < anxiety −0.090, −0.110 −0.069, taking ≥10 medications −0.065, −0.085 −0.046, sarcopenia −0.062, −0.080 −0.043, .001) haemoglobin <100 g/L −0.047, −0.010, .012) pain −0.134, −0.152 −0.117, .001). Smoking prescription prednisolone independently self-care activities respectively. Renin–angiotensin system inhibitor (RASi) fewer mobility activities. Conclusion Potentially obesity, pain, depression, anxiety, anaemia, polypharmacy, smoking, steroid use this cohort, whilst RASi was better two dimensions.
Language: Английский
Citations
3
Frontiers in Pharmacology, Journal Year: 2023, Volume and Issue: 14
Published: Feb. 10, 2023
Background and objectives: Polypharmacy chronic kidney disease (CKD) are becoming increasingly common due to an ageing population the rise of multimorbidity. In line with therapeutic guidelines, managing CKD its complications necessitates prescribing multiple medications, which predisposes patients polypharmacy. The aim this systematic review meta-analysis is describe prevalence polypharmacy in explore global trends factors driving any apparent variability estimates. Methods: PubMed, Scopus, Cochrane Database Systematic Reviews (CDSR), Google Scholar were searched from 1999 November 2021. Study selection, data extraction, critical appraisal conducted by two independent reviewers. pooled was estimated utilizing random effects model using default double arcsine transformation. Results: This involved 14 studies comprising 17 201 participants, a significant proportion males (56.12%). mean age 61.96 (SD ± 11.51) years. overall amongst 69% (95% CI: 49%–86%) (I 2 = 100%, p < 0.0001), proportionately higher North America Europe as compared Asia. Conclusion: results showed high estimates patient cohorts CKD. exact interventions that likely significantly mitigate effect remain uncertain will need exploration future prospective studies. Review Registration : [ https://www.crd.york.ac.uk/prospero/ ], identifier [CRD42022306572].
Language: Английский
Citations
9
Frontiers in Pharmacology, Journal Year: 2022, Volume and Issue: 13
Published: Oct. 14, 2022
Older hospitalized patients with chronic kidney disease (CKD) are part of the geriatric population a substantial risk potentially inappropriate medication (PIM) use. The high rates multimorbidity and polypharmacy, along progressive decline eGFR, contribute to increasing drug-drug drug-disease interactions, overdosing, adverse drug reactions (ADRs). In this multicenter cross-sectional study, we aimed evaluate prevalence CKD under-reporting PIMs among older discharged from acute nephrology units throughout Italy. Renal function was determined by estimated glomerular filtration rate (eGFR) through Berlin Initiative Study (BIS) equation; calculated revising prescriptions at discharge according STOPP criteria, Beers summaries product characteristics (smPCs). A descriptive analysis performed compare clinical pharmacological in two distinct settings; univariate multivariate logistic regression models were explore factors associated report forms PIM prevalence. Overall, study consisted 2,057 patients, aged 83 (77-89) years, more commonly women, median seven (5-10) drugs prescribed discharge. present 50.8% population, higher vs. (71.1% 10.2%, p < 0.001). 18.5% least one renally medication; contraindicated number (PR 1.09, 95% CI 1.14-1.19); atrial fibrillation 1.35, 1.01-1.81); diabetes 1.61, 1.21-2.13); being 1.62, 1.14-2.31), stage 3b 2.35, 1.34-4.13), 4-5 14.01, 7.36-26.72). Conversely, not outcome. summary, use common hospital; relatively both settings underlines need improve appropriate prescribing during hospital stay decrease ADRs side effects highly vulnerable population.
Language: Английский
Citations
12
Toxins, Journal Year: 2021, Volume and Issue: 13(2), P. 91 - 91
Published: Jan. 26, 2021
Chronic kidney disease (CKD) is a highly prevalent condition and associated with high comorbidity burden, polymedication, mortality rate. A number of conventional nonconventional risk factors for comorbidities in CKD have been identified. Among the factors, uremic toxins are valuable therapeutic targets. The fact that some gut-derived suggests intestinal chelators might effect. phosphate binders used to prevent hyperphosphatemia hemodialysis patients act by complexing inorganic gastrointestinal tract but conceivably nonspecific action on toxins. Since phosphorous major nutrient survival reproduction bacteria, changes its concentration may impact gut microbiota’s activity composition. Furthermore, AST-120 an orally administered activated charcoal adsorbent widely Asian countries specifically decrease toxin levels. In this narrative review, we examine latest data use oral specific reduce levels
Language: Английский
Citations
15
Age and Ageing, Journal Year: 2022, Volume and Issue: 51(8)
Published: June 30, 2022
Abstract Chronic kidney disease (CKD) is defined as abnormalities of structure or function, present for >3 months, with implications health. The most used diagnostic criteria are a urinary albumin: creatinine ratio ≥30 mg/g an estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2. Either these thresholds associated adverse health outcomes. GFR decreases age and the prevalence CKD highest in older adults; moreover, presence increased risk all-cause cardiovascular death related to accelerated ageing all ranges, absolute increase those aged >75 years. Indeed, premature more common outcome than progression failure requiring replacement therapy. progressive world population contributes projection that will become second cause before end century countries long life expectancy. current collection selected studies on published Age&Ageing, NDT CKJ provides overview key topics, including cognitive decline, sarcopaenia, wasting non-cardiovascular morbidity mortality, management gender differences progression.
Language: Английский
Citations
10
BMC Geriatrics, Journal Year: 2023, Volume and Issue: 23(1)
Published: April 29, 2023
Abstract Background Shared decision-making(SDM) is recognized as an important means of managing polypharmacy among older people with chronic diseases. However, no studies have quantitatively measured the effect SDM on polypharmacy. The objective this study was to compare impact and other factors in inpatients community patients. Additionally, aimed different decision types Methods This a population-based multicenter retrospective conducted Hubei Province, China. A cluster sampling approach used recruit 536 disease from March April 2019, 849 patients were recruited June 2021. Propensity score weighting control confounding variables determine net Results Among hospitalized patients, prevalence 56.3%. high level significantly associated lower risk Patients illnesses aged 76 years annual family income 24,001–36,000 yuan likelihood ( p < 0.05). Multimorbidity often accompanied by occurrence multiple medication use. 21.8%. decision-making, informed paternalistic decision-making showed higher compared shared P Male, over age, urban residents, household 12,001–24,000 yuan, multimorbidity 36,001 or more, good compliance Conclusions China's population who should be paid more atthention healthcare providers. Additionaly, encouraging patients' attendance SDM, reducing during prescribing, improving patient compliance, increasing promotion guidance rational use for are essential reduce Chinese
Language: Английский
Citations
5
Nephrology Dialysis Transplantation, Journal Year: 2021, Volume and Issue: 37(11), P. 2284 - 2292
Published: March 29, 2021
The uraemic toxins that accumulate as renal function deteriorates can potentially affect drug pharmacokinetics. This study's objective was to determine whether plasma concentrations of certain are correlated with blood two immunosuppressants.DRUGTOX a cross-sectional study 403 adult patients followed up after kidney transplantation and who had undergone therapeutic monitoring (TDM) calcineurin inhibitors (tacrolimus or cyclosporin) between August 2019 March 2020. For each patient, immunosuppressant trough (C0) were measured in whole samples then normalized against the total daily dose (C0:D ratio). sample assayed for five [urea, trimethylamine N-oxide (TMAO), indole acetic acid (IAA), p-cresylsulphate (PCS) indoxylsulphate (IxS)] using liquid chromatography-tandem mass spectrometry.The median age 56 years [interquartile range (IQR) 48-66] estimated glomerular filtration rate 41 mL/min/1.73 m2 (IQR 30-57). Age, sex, body index (BMI), urea, IxS PCS significantly associated an increment tacrolimus C0:D ratio. A multivariate analysis revealed independent association [odds ratio 1.36 (95% confidence interval 1.00-1.85)] adjustment BMI, whereas weakened urea. In univariate logistic analysis, age, BMI TMAO level (but not PCS, IxS, IAA urea) cyclosporine ratio.Even though TDM adaptation immunosuppressants keep levels within window, increased exposure cyclosporine) is accumulation
Language: Английский
Citations
12
Journal of Bone and Mineral Metabolism, Journal Year: 2021, Volume and Issue: 40(1), P. 157 - 166
Published: Nov. 3, 2021
Language: Английский
Citations
11
British Journal of Clinical Pharmacology, Journal Year: 2024, Volume and Issue: unknown
Published: Dec. 30, 2024
Structured medication reviews (SMRs) were introduced into the National Health Service (NHS) Primary Care to support delivery of NHS Long-Term Plan for medicines optimization. SMRs improve quality care, reduce harm and offer value money. However, evidence patients with chronic kidney disease (CKD) stage G4-5D elevated risk cardiovascular premature mortality is unknown. This scoping review aimed assess extent nature SMR research in population CKD G4-5D. Electronic databases searched on 20 October 2023. Studies eligible if they described an adults G4-5D, regardless study design. Data detailing global patterns, intervention descriptions, professionals performing SMR, reported areas future extracted. The extracted outcome data categorized as clinical, patient-important, medication-related experience-related. A narrative synthesis was completed. Seventeen studies (81%) conducted nephrology outpatient settings, three (14%) during acute hospital admissions one (5%) within community pharmacy. Eighteen (86%) quantitative, including five randomized controlled trials. Ten (48%) undertaken United States Canada, two Europe (France Norway). No such have been Kingdom. Our revealed that there a lack strategy polypharmacy harms from Therefore, further required this area.
Language: Английский
Citations
1