Polypharmacy and medication use in patients with chronic kidney disease with and without kidney replacement therapy compared to matched controls

Clinical Kidney Journal, Год журнала: 2021, Номер 14(12), С. 2497 - 2523

Опубликована: Июнь 28, 2021

This study aims to examine polypharmacy (PP) prevalence in patients with chronic kidney disease (CKD) Stage G4/G5 and replacement therapy (KRT) compared matched controls from the general population. Furthermore, we risk factors for PP describe most commonly dispensed medications.Dutch health claims data were used identify three patient groups: CKD G4/G5, dialysis transplant patients. Each was two based on age, sex socio-economic status (SES) score. We differentiated between 'all medication use' 'chronic use'. defined at levels: use of ≥5 medications (PP), ≥10 [excessive (EPP)] ≥15 [hyper (HPP)].The all 87, 93 95% patients, respectively. For use, this 66, 70 75%, comorbidity higher than controls. EPP 42 times more common young (ages 20-44 years) controls, while ratio 3.8 ≥75 years. Older age (64-75 a factor Dialysis years had lower their younger counterparts. Additional low SES, diabetes mellitus, vascular disease, hospitalization an emergency room visit. The proton pump inhibitors (PPIs) statins.CKD KRT have high burden, far beyond that individuals population, as result large burden comorbidities. A critical approach prescription general, specific like PPIs statins (in population), could be first step towards appropriate use.

Язык: Английский

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Statins, Mortality, and Major Adverse Cardiovascular Events Among US Veterans With Chronic Kidney Disease

JAMA Network Open, Год журнала: 2023, Номер 6(12), С. e2346373 - e2346373

Опубликована: Дек. 6, 2023

Importance There are limited data for the utility of statins primary prevention atherosclerotic cardiovascular disease (ASCVD) and death in adults with chronic kidney (CKD). Objective To evaluate association statin use all-cause mortality major adverse events (MACE) among US veterans older than 65 years CKD stages 3 to 4. Design, Setting, Participants This cohort study used a target trial emulation design initiation moderate (stages or 4) using nested trials propensity weighting approach. Linked Veterans Affairs (VA) Healthcare System, Medicare, Medicaid were used. considered newly diagnosed between 2005 2015 VA, follow-up through December 31, 2017. years, within 5 diagnosis, had no prior ASCVD use, at least 1 clinical visit year baseline. Eligibility criteria assessed each trial, Cox proportional hazards models bootstrapping run. Analysis was conducted from July 2021 October 2023. Exposure Statin vs none. Main Outcomes Measures Primary outcome mortality; secondary time first MACE (myocardial infarction, transient ischemic attack, stroke, revascularization, mortality). Results Included analysis 14 828 veterans. Mean (SD) age diagnosis 76.9 (8.2) 616 (99%) men, 10 539 (72%) White, 2568 (17%) Black. After expanding person-trials assessing eligibility baseline, there 151 243 (14 685 individuals) nonstatin initiators 2924 (2924 included. Propensity score adjustment via overlap nonparametric resulted covariate balance, mean 3.6 (2.7) years. The hazard ratio 0.91 (95% CI, 0.85-0.97) comparing noninitiators. 0.96 0.91-1.02). remained consistent prespecified subgroup analyses. Conclusions Relevance In this 4 ASCVD, significantly associated lower risk but not MACE. should be confirmed randomized trial.

Язык: Английский

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Tackling the Inverse Care Law with pharmacist-led cardio-renal-metabolic service in a socioeconomically deprived population: A prospective scoping intervention study

Research Square (Research Square), Год журнала: 2025, Номер unknown

Опубликована: Март 20, 2025

Background Chronic kidney disease (CKD) is a leading cause of premature mortality, often coexisting with cardiovascular and diabetes mellitus; disproportionately affecting socioeconomically deprived groups. CKD projected to increase due ageing, obesity diabetes. General practice clinical pharmacists (GPCPs) have been shown be effective in challenging chronic prescribing. GPCP services for remains underexplored. Aim To scope the potential GPCP-led multidisciplinary intervention optimise cardio-renal metabolic risk factors stages 3–4. Method Adults 3a 4 from two urban, general practices NHS Greater Glasgow Clyde UK, were identified via records GP referrals. Eligible patients invited attend clinic (Nov 2021 – Jan 2024), that included monitoring (primary measure), patient education, life-style advice medicines optimisation. Anonymised pre- post-intervention data analysed. Results In total, 253 participants (median age 77, range 26 99) met inclusion criteria; 62% lived most areas Scotland; female. Of 163 (64%) attending. eGFR increased by mean 2.9 (95% CI 1.41 4.40, p < 0.001) ml/min/1.73m² over 12 months, improvements staging, blood pressures, lipid profiles, HbA1c. Medicines optimisation lowering (62%), antihypertensives (47%), sodium-glucose co-transporter-2 inhibitors (42%), adverse drug effect management (16%), including nephrotoxic cessation. Conclusion An integrated pharmacist-led, practice-based clinic, improved key CKD-related outcomes population. Further studies are needed confirm long-term impact.

Язык: Английский

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Less is More: Deprescribing Medications in Older Adults with Kidney Disease: A Review

Kidney360, Год журнала: 2021, Номер 2(9), С. 1510 - 1522

Опубликована: Июль 9, 2021

Due to age and impaired kidney function, older adults with disease are at increased risk of medication-related problems related hospitalizations. One proa ctive approach minimize this is deprescribing. Deprescribing refers the systematic process reducing or stopping a medication. Aside from preventing harm, deprescribing can potentially optimize patients’ quality life by aligning medications their goals care. For some patients, could involve less aggressive management diabetes and/or hypertension. In other instances, targets may include inappropriate that carry greater harm than benefit in adults, have questionable efficacy, including varying efficacy degree increase medication regimen complexity. We guide for clinicians utilize deprescribing, List, Evaluate, Shared Decision-Making, Support (LESS) framework. The LESS framework provides key considerations each step be tailored context individu al patients. Patient characteristics clinical events warrant consideration limited expectancy, cognitive impairment, health status changes, such as dialysis initiation recent hospitalization. acknowledge patient-, clinician-, system-level challenges depre scribing process. These patient hesitancy discussing care, clinician time constraints lack evidence-based guidelines, interoperable electronic records incentives However, novel tools designed facilitate future evidence on effectiveness help mitigate these barriers. This review foundational knowledge an emerging component practice research within nephrology.

Язык: Английский

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Attitudes of Older Adult Patients and Caregivers Towards Deprescribing of Medications in Ethiopia

Clinical Interventions in Aging, Год журнала: 2023, Номер Volume 18, С. 1129 - 1143

Опубликована: Июль 1, 2023

Deprescribing is essential for reducing inappropriate medication use and polypharmacy. For a holistic approach, it to know how older adult patients their caregivers perceive deprescribing.To assess the attitude of towards deprescribing at Ambo University Referral Hospital.Institutional-based cross-sectional study was conducted using revised Patients' Attitude Towards tool (rPATD). The data analyzed SPSS-25 software. Backward linear regression logistic were used measure association between outcome determinant variables. two-sided P-value ≤0.05 with 95% confidence interval utilized reporting significant factors.One hundred fifty-six (81.3%) respondents (ie, 85.0% 77.2% caregivers) agreed stop one or more regular medications if physician said possible despite 98 (51.0%) them 49.0% 53.3% being satisfied their/their care recipient's medications. On overall aggregate mean score, had neutral position (2.6-3.59) regarding burden concerns stopping whereas majority disagree (1.0-2.59) inappropriateness they taking (3.6-5.0) need involvement in treatment decision making. Concerns about medicine scores (AOR = 0.440, CI 0.262-0.741, P 0.035) perceived levels 0.653, 0.456-0.936, 0.020) significantly associated willingness discontinue satisfaction regimen respectively.The would like deprescribe physicians recommended it. medicines respectively. Healthcare providers should prompt process by addressing

Язык: Английский

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A Pilot Study Embedding Clinical Pharmacists Within an Interprofessional Nephrology Clinic for the Initiation and Monitoring of Empagliflozin in Diabetic Kidney Disease

Journal of Pharmacy Practice, Год журнала: 2019, Номер 34(3), С. 428 - 437

Опубликована: Сен. 24, 2019

The American Diabetes Association (ADA) recommends sodium-glucose cotransporter-2 (SGLT2) inhibitors as the second medication to be started, after metformin, for patients with chronic kidney disease (CKD). Sodium-glucose may cause volume, blood pressure, and electrolyte disturbances; consequently, frequent monitoring adjustments other diabetes, and/or diuretic medications necessary.To evaluate safety efficacy of an interprofessional clinic model partnering nephrologists pharmacists initiation SGLT2 inhibitors.A clinical pharmacist was embedded within nephrology provide patient education, telephone follow-up, work collaboratively nephrologists. Diabetes, hypertension, regimens were adjusted needed empagliflozin initiation. adhere 2019 ADA guidelines that promote agents CKD atherosclerotic cardiovascular benefit.Fourteen initiated on during study period. Urine albumin-to-creatinine ratio (UACR) improved (mean % change -12% ± 61%); mean percentage greater in a higher baseline UACR. hemoglobin A1c 0.3% 0.6%. Common adverse reactions observed over time; no serious drug occurred. Finally, necessitated almost all (n = 13, 93%).The implementation innovative, care DKD demonstrated benefit minimal concerns.

Язык: Английский

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Impact of interventions targeting the inappropriate use of proton‐pump inhibitors by clinical pharmacists in a hepatobiliary surgery department

Journal of Clinical Pharmacy and Therapeutics, Год журнала: 2020, Номер 46(1), С. 149 - 157

Опубликована: Окт. 5, 2020

What is known and Objective At present, studies on the usage of proton-pump inhibitors (PPIs) have universal significance. In clinical practice, PPIs are widely used to treat a variety acid-related diseases, but they can be inappropriately prescribed, leading increased medical costs patient harm. The study comprehensively evaluated effects pharmacist intervention inappropriate PPI prescriptions in tertiary general hospital hepatobiliary surgery ward. Methods A retrospective, single-centre covering periods July-December 2018 2019 was conducted. group, pharmaceutical care initiated by Outcomes, including pattern utilization, rate use safety outcomes, were compared between two periods. Results discussion total, 1150 patients admitted ward our Of these, 717 met inclusion criteria for this study, 420 297 included preintervention post-intervention groups, respectively. utilization rates before after 82.0% 55.0%, 48.9 22.7 per 100 patient-days, Clinical outcomes nearly identical intervention, treated with more likely experience nosocomial pneumonia (2.4% vs. 0.6%). new Conclusion implementation decreased during hospitalization without sacrificing outcomes.

Язык: Английский

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The missing piece: Clinical pharmacists enhancing the interprofessional nephrology clinic model

Journal of the American Pharmacists Association, Год журнала: 2019, Номер 59(5), С. 727 - 735

Опубликована: Июнь 21, 2019

Язык: Английский

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Sodium-glucose cotransporter 2 inhibitors for diabetic kidney disease: a primer for deprescribing

Clinical Kidney Journal, Год журнала: 2019, Номер 12(5), С. 620 - 628

Опубликована: Июль 9, 2019

Chronic kidney disease (CKD) is a critical global public health problem associated with high morbidity and mortality, poorer quality of life increased care expenditures. CKD its comorbidities are one the most complex clinical constellations to manage. Treatments for lead polypharmacy, which exponentiates mortality. Sodium-glucose cotransporter 2 inhibitors (SGLT2is) have shown remarkable benefits in cardiovascular renal protection patients type diabetes mellitus (T2DM). The pleiotropic effects SGLT2is beyond glycosuria suggest promising role reducing polypharmacy diabetic CKD, but potential adverse should also be considered. In this review, we present typical case patient multiple seen clinic, highlighting complexity management proteinuria, hyperkalemia, volume overload, hyperuricemia, hypoglycemia obesity. We review context trials current guidelines. then discuss roles controversies SGLT2is. conclude proposal deprescribing principles when initiating CKD.

Язык: Английский

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Challenges to Implementing Environmentally Sustainable Kidney Care in LMICs: An Opinion Piece

Canadian Journal of Kidney Health and Disease, Год журнала: 2024, Номер 11

Опубликована: Янв. 1, 2024

Язык: Английский

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