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Hall RK, Kazancıoğlu R, Thanachayanont T, Wong G, Sabanayagam D, Battistella M, Ahmed SB, Inker LA, Barreto EF, Fu EL, Clase CM, Carrero JJ. Drug stewardship in chronic kidney disease to achieve effective and safe medication use. Nat Rev Nephrol 2024; 20:386-401. [PMID: 38491222 DOI: 10.1038/s41581-024-00823-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2024] [Indexed: 03/18/2024]
Abstract
People living with chronic kidney disease (CKD) often experience multimorbidity and require polypharmacy. Kidney dysfunction can also alter the pharmacokinetics and pharmacodynamics of medications, which can modify their risks and benefits; the extent of these changes is not well understood for all situations or medications. The principle of drug stewardship is aimed at maximizing medication safety and effectiveness in a population of patients through a variety of processes including medication reconciliation, medication selection, dose adjustment, monitoring for effectiveness and safety, and discontinuation (deprescribing) when no longer necessary. This Review is aimed at serving as a resource for achieving optimal drug stewardship for patients with CKD. We describe special considerations for medication use during pregnancy and lactation, during acute illness and in patients with cancer, as well as guidance for the responsible use of over-the-counter drugs, herbal remedies, supplements and sick-day rules. We also highlight inequities in medication access worldwide and suggest policies to improve access to quality and essential medications for all persons with CKD. Further strategies to promote drug stewardship include patient education and engagement, the use of digital health tools, shared decision-making and collaboration within interdisciplinary teams. Throughout, we position the person with CKD at the centre of all drug stewardship efforts.
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Affiliation(s)
- Rasheeda K Hall
- Division of Nephrology, Department of Medicine, and Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | | | | | - Germaine Wong
- Sydney School of Public Health, University of Sydney, Sydney, Australia
| | | | | | - Sofia B Ahmed
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Lesley A Inker
- Division of Nephrology, Department of Internal Medicine, Tufts Medical Center, Boston, MA, USA
| | | | - Edouard L Fu
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, USA
| | - Catherine M Clase
- Department of Medicine and Health Research Methods, Evidence and Impact, McMaster University, Ontario, Canada
| | - Juan J Carrero
- Medical Epidemiology and Biostatistics, Karolinska Institutet, and Division of Nephrology, Department of Clinical Sciences, Danderyd Hospital, Stockholm, Sweden.
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Pehlivanli A, Akkan Eren S, Sengul S, Basgut B, Erturk S, Ozcelikay AT. Determination of drug-related problems according to PAIR criteria in dialysis patients: a cross-sectional study in tertiary care hospital. BMC Pharmacol Toxicol 2024; 25:28. [PMID: 38637817 PMCID: PMC11025200 DOI: 10.1186/s40360-024-00754-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 04/10/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND Dialysis patients are at high risk for drug-related problems (DRPs), which have significant consequences for their morbidity, mortality, and quality of life. Improved clinical outcomes can be achieved by preventing, identifying, and resolving these problems. METHODS This is a retrospective observational study. In this study, the PAIR instrument (Pharmacotherapy Assessment in Chronic Renal Disease) was validated for use in Turkish. Validation consisted of three stages: translation back-translation with expert panel evaluation, reliability analysis using the test-retest method, and conceptual validity with both Pharmaceutical Care Network Europe (PCNE) and PAIR used to determine DRPs prevalence. RESULTS In total, 104 patients (mean ± SD age, 54.1 ± 15.8 years; 53.8% male) were included in the study. An expert panel evaluated the items in the criterion based on their intelligibility, service of purpose, differentiation, and cultural suitability during the translation stage. Content validity index (CVI) score was found to be 0.95. The reliability analysis was performed by applying the test-retest method and calculating correlation coefficient on 30 randomly selected patients one month later. Correlation coefficient (p) was found to be 0.8. To evaluate conceptual validity, 104 patients' pharmacotherapy plans were assessed using both the PAIR and PCNE criteria. The prevalence of DRPs according to PAIR criteria (100.0%) and PCNE (73.1%) were statistically significantly different (p < 0.001). CONCLUSIONS As a result, PAIR criteria can identify clinically relevant DRPs in patients with CKD and is a new, validated tool to be used in Turkey, but may not be adequate for patients receiving dialysis. Therefore, it needs to be reviewed and updated for dialysis patients.
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Affiliation(s)
- Aysel Pehlivanli
- Faculty of Pharmacy, Department of Pharmacology, Baskent University, Ankara, Turkey.
- Faculty of Pharmacy, Department of Clinical Pharmacy, Ankara University, Ankara, Turkey.
| | - Sayeste Akkan Eren
- Department of Nephrology, Ankara University, School of Medicine, Ankara, Turkey
| | - Sule Sengul
- Department of Nephrology, Ankara University, School of Medicine, Ankara, Turkey
| | - Bilgen Basgut
- Faculty of Pharmacy, Department of Pharmacology, Baskent University, Ankara, Turkey
| | - Sehsuvar Erturk
- Department of Nephrology, Ankara University, School of Medicine, Ankara, Turkey
| | - A Tanju Ozcelikay
- Faculty of Pharmacy, Department of Pharmacology, Ankara University, Ankara, Turkey
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Stevens PE, Ahmed SB, Carrero JJ, Foster B, Francis A, Hall RK, Herrington WG, Hill G, Inker LA, Kazancıoğlu R, Lamb E, Lin P, Madero M, McIntyre N, Morrow K, Roberts G, Sabanayagam D, Schaeffner E, Shlipak M, Shroff R, Tangri N, Thanachayanont T, Ulasi I, Wong G, Yang CW, Zhang L, Levin A. KDIGO 2024 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney Int 2024; 105:S117-S314. [PMID: 38490803 DOI: 10.1016/j.kint.2023.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 10/31/2023] [Indexed: 03/17/2024]
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Hamzaei Z, Houlind MB, Kjeldsen LJ, Christensen LWS, Walls AB, Aharaz A, Olesen C, Coric F, Revell JHP, Ravn-Nielsen LV, Andersen TRH, Hedegaard U. Inappropriate prescribing in patients with kidney disease: A rapid review of prevalence, associated clinical outcomes and impact of interventions. Basic Clin Pharmacol Toxicol 2024; 134:439-459. [PMID: 38348501 DOI: 10.1111/bcpt.13986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 01/11/2024] [Accepted: 01/17/2024] [Indexed: 03/16/2024]
Abstract
BACKGROUND The prevalence of patients with chronic kidney disease (CKD) and polypharmacy is increasing and has amplified the importance of examining inappropriate prescribing (IP) in CKD. This review focuses on the latest research regarding the prevalence of IP in CKD and the related adverse clinical effects and explores new interventions against IP. METHOD A literature search was performed using PubMed, EMBASE and the Cochrane Library searching articles published between June 2016 and March 2022. RESULTS Twenty-seven studies were included. An IP prevalence of 12.6% to 96% and 0.3% to 66% was reported in hospital and outpatient settings, respectively. In nonhospital settings, the prevalence of IP varied between 3.9% and 60%. IP was associated with higher risk of hospitalisation (HR 1.46, 95% CI 1.17-1.81), higher bleeding rate (HR 2.34, 95% CI 1.32 to 3.37) and higher risk of all-cause mortality (OR 1.07, 95% CI 1.02 to 1.13). Three studies reported the impact of interventions on IP. CONCLUSION This review highlights widespread IP in CKD patients across healthcare settings, with varying prevalence rates. IP is substantially linked to adverse outcomes in patients. While limited interventions show promise, urgent research is needed to develop effective strategies addressing IP and improving CKD patient care.
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Affiliation(s)
- Zohra Hamzaei
- Clinical Pharmacology, Pharmacy and Environmental Medicine, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Morten Baltzer Houlind
- The Capital Region Pharmacy, Herlev, Denmark
- Department of Clinical Research, Copenhagen University Hospital-Amager and Hvidovre, Hvidovre, Denmark
- Department of Drug Design and Pharmacology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | - Louise Westberg Strejby Christensen
- The Capital Region Pharmacy, Herlev, Denmark
- Department of Clinical Research, Copenhagen University Hospital-Amager and Hvidovre, Hvidovre, Denmark
| | - Anne Byriel Walls
- Department of Drug Design and Pharmacology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- The Capital Region Hospital Pharmacy, Copenhagen, Denmark
| | - Anissa Aharaz
- Department of Clinical Research, Copenhagen University Hospital-Amager and Hvidovre, Hvidovre, Denmark
| | | | - Faruk Coric
- Hospital Pharmacy Funen, Odense University Hospital, Odense, Denmark
| | | | | | | | - Ulla Hedegaard
- Clinical Pharmacology, Pharmacy and Environmental Medicine, Department of Public Health, University of Southern Denmark, Odense, Denmark
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Aljawadi MH, Babaeer AA, Alghamdi AS, Alhammad AM, Almuqbil MS, Alonazi KF. Quality of life tools among patients on dialysis: A systematic review. Saudi Pharm J 2024; 32:101958. [PMID: 38322149 PMCID: PMC10845059 DOI: 10.1016/j.jsps.2024.101958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 01/11/2024] [Indexed: 02/08/2024] Open
Abstract
Introduction The universal increase in obesity and diabetes has increased the chronic kidney disease (CKD) rate. In 2017, almost 800 million individuals suffered from CKD worldwide. Kidney dialysis becomes necessary as the disease progresses. Dialysis negatively impacts CKD patients' quality of life (QoL). It causes several complications that affect patients' physical, social, psychological, and spiritual aspects of life. This systematic review aims to identify condition-specific tools used to assess CKD patients' quality of life on dialysis. Material and Methods A systematic literature search was conducted to investigate studies using QoL tools among patients on dialysis from February 2000 to June 2023. The search was conducted in several databases and followed the PRISMA guidelines. The focus was to identify tools that capture intrinsic factors, such as spiritual subdomains, rather than extrinsic factors, such as environmental subdomains. Results The review identified five studies and seven dialysis-specific tools for assessing the QoL of CKD patients on dialysis. The physical domain was the most assessed, followed by the psychological and social domains. Fatigue, muscle weakness, sleep disorders, and pain were identified as the most common concerns in the physical domain. Conclusion Dialysis negatively impacts all aspects of QoL in CKD patients. This review can guide clinicians in understanding the disease and treatment burden by identifying the most appropriate tools for assessing the QoL of adult CKD patients undergoing dialysis. There is a need for further studies to explore the detrimental effects of CKD treatment and better understand its impact on patients' QoL.
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Affiliation(s)
- Mohammad H. Aljawadi
- Clinical Pharmacy Department, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | | | | | - Abdullah M. Alhammad
- Clinical Pharmacy Department, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Mansour S. Almuqbil
- Clinical Pharmacy Department, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
- Department of Pharmacy Practice, College of Pharmacy, AlMaarefa University, Riyadh, Saudi Arabia
| | - Khalid F Alonazi
- Clinical Pharmacy Department, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
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Onor IO, Ahmed F, Nguyen AN, Ezebuenyi MC, Obi CU, Schafer AK, Borghol A, Aguilar E, Okogbaa JI, Reisin E. Polypharmacy in chronic kidney disease: Health outcomes & pharmacy-based strategies to mitigate inappropriate polypharmacy. Am J Med Sci 2024; 367:4-13. [PMID: 37832917 DOI: 10.1016/j.amjms.2023.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Revised: 10/06/2023] [Accepted: 10/09/2023] [Indexed: 10/15/2023]
Abstract
The rising prevalence of comorbidities in an increasingly aging population has sparked a reciprocal rise in polypharmacy. Patients with chronic kidney disease (CKD) have a greater burden of polypharmacy due to the comorbidities and complications associated with their disease. Polypharmacy in CKD patients has been linked to myriad direct and indirect costs for patients and the society at large. Pharmacists are uniquely positioned within the healthcare team to streamline polypharmacy management in the setting of CKD. In this article, we review the landscape of polypharmacy and examine its impacts through the lens of the ECHO model of Economic, Clinical, and Humanistic Outcomes. We also present strategies for healthcare teams to improve polypharmacy care through comprehensive medication management process that includes medication reconciliation during transitions of care, medication therapy management, and deprescribing. These pharmacist-led interventions have the potential to mitigate adverse outcomes associated with polypharmacy in CKD.
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Affiliation(s)
- IfeanyiChukwu O Onor
- College of Pharmacy, Xavier University of Louisiana, New Orleans, LA, USA; Department of Medicine, Louisiana State University Health Sciences Center School of Medicine, New Orleans, LA, USA; Department of Pharmacy, University Medical Center New Orleans, New Orleans, LA, USA.
| | - Fahamina Ahmed
- College of Pharmacy, Xavier University of Louisiana, New Orleans, LA, USA; East Jefferson General Hospital-Family Medicine Clinic, Metairie, LA, USA
| | - Anthony N Nguyen
- Department of Pharmacy, Ochsner Health System, Jefferson, LA, USA
| | - Michael C Ezebuenyi
- Department of Pharmacy, Our Lady of the Lake Regional Medical Center, Baton Rouge, LA, USA
| | - Collins Uchechukwu Obi
- Medical Laboratory Science Department, Nnamdi Azikiwe University, Nnewi Campus, Anambra, Nigeria
| | - Alison K Schafer
- Department of Medicine, Louisiana State University Health Sciences Center School of Medicine, New Orleans, LA, USA
| | - Amne Borghol
- College of Pharmacy, Xavier University of Louisiana, New Orleans, LA, USA; Department of Medicine, Louisiana State University Health Sciences Center School of Medicine, New Orleans, LA, USA; Department of Pharmacy, University Medical Center New Orleans, New Orleans, LA, USA
| | - Erwin Aguilar
- Department of Medicine, Section of Nephrology and Hypertension, Louisiana State University Health Sciences Center School of Medicine, New Orleans, LA, USA
| | - John I Okogbaa
- College of Pharmacy, Xavier University of Louisiana, New Orleans, LA, USA; Department of Medicine, Louisiana State University Health Sciences Center School of Medicine, New Orleans, LA, USA
| | - Efrain Reisin
- Department of Medicine, Section of Nephrology and Hypertension, Louisiana State University Health Sciences Center School of Medicine, New Orleans, LA, USA
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Kyomya J, Atwiine F, Shegena EA, Muhindo R, Yadesa TM. Drug-related problems and associated factors among patients with kidney dysfunction at a tertiary hospital in southwestern Uganda: a prospective observational study. BMC Nephrol 2023; 24:375. [PMID: 38114948 PMCID: PMC10731752 DOI: 10.1186/s12882-023-03437-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 12/12/2023] [Indexed: 12/21/2023] Open
Abstract
BACKGROUND Kidney dysfunction is a common, progressive condition that is increasingly becoming a global public health issue. Because the kidneys are the major route for drug excretion, impaired renal function can change the pharmacokinetics and pharmacodynamics of drugs that are renally excreted. Additionally, patients with kidney dysfunction often have co-morbidities and the associated use of multiple medications which increases the risk of drug-related problem (DRP) occurrence. This study aimed to determine the prevalence, types, and factors associated with DRPs in patients with kidney dysfunction. METHOD We conducted a prospective observational study over 3 months among hospitalized patients diagnosed with acute kidney injury or chronic kidney disease who were hospitalized in the medical ward, and patients attending the renal outpatient clinic at Mbarara Regional Referral Hospital. A total of 183 participants were enrolled through the use of a consecutive sampling technique. DRPs were classified according to the PCNE classification version 9.1. Data analysis was carried out using SPSS version 25. RESULTS A total of 174 patients with kidney dysfunction were included in the study with a mean ± SD age of 50.34 ± 18.13 years. A total of 219 DRPs were incurred by 138 (79.3%) study participants. The most common DRPs were 'Untreated symptoms or indication' (35.6%) followed by 'adverse event (possibly) occurring' (28.3%), and 'effect of drug treatment not optimal' (23.3%). Antimicrobials were the most involved drugs in suboptimal drug treatment (31.3%) and unnecessary drug treatment (32.1%). The study showed that length of hospital stay ≥ 5 days (AOR = 6.39, 95% CI: 1.75-23.27; p-value = 0.005) significantly increased the risk of DRP occurrence. CONCLUSION The current results, in agreement with previous literature, showed a high burden of DRPs among patients with kidney dysfunction. Antimicrobials were the most involved drugs in suboptimal as well as in unnecessary drug treatment. Longer hospital stay significantly increased the risk of DRPs. The high prevalence of DRPs in patients with kidney dysfunction and the potential impact on antimicrobial resistance underscores the importance of regular medication reviews and close monitoring of patients with renal dysfunction.
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Affiliation(s)
- Julius Kyomya
- Department of Pharmacy, Faculty of Medicine, Mbarara University of Science and Technology, P. O. Box 1410, Mbarara, Uganda.
| | - Fredrick Atwiine
- Department of Pharmacy, Faculty of Medicine, Mbarara University of Science and Technology, P. O. Box 1410, Mbarara, Uganda
| | - Efrata Ashuro Shegena
- Department of Pharmacy, Faculty of Medicine, Mbarara University of Science and Technology, P. O. Box 1410, Mbarara, Uganda
| | - Rose Muhindo
- Department of Internal Medicine, Faculty of Medicine, Mbarara University of Science and Technology, P. O. Box 1410, Mbarara, Uganda
| | - Tadele Mekuriya Yadesa
- Department of Pharmacy, Faculty of Medicine, Mbarara University of Science and Technology, P. O. Box 1410, Mbarara, Uganda
- Department of Clinical Pharmacy and Pharmacy Practice, School of Pharmacy, Kampala International University, Ishaka, Uganda
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Zhu L, Liu Y, Yang F, Yu S, Fu P, Yuan H. Prevalence, associated factors and clinical implications of medication literacy linked to frailty in hemodialysis patients in China: a cross-sectional study. BMC Nephrol 2023; 24:307. [PMID: 37875849 PMCID: PMC10594921 DOI: 10.1186/s12882-023-03346-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Accepted: 09/22/2023] [Indexed: 10/26/2023] Open
Abstract
BACKGROUND Maintenance hemodialysis (MHD) patients have complex medication regimens that require a high level of skill to interpret medication information. However, there is currently a lack of research evaluating the ability to read and understand medication labels in Chinese MHD patients. In addition, the relationship between frailty and medication literacy among MHD patients remains unclear. Therefore, this study aims to assess the potential factors affecting medication literacy in MHD patients and to explore the relationship between frailty and medication literacy. METHODS This cross-sectional study was conducted using convenience sampling in West China Hospital of Sichuan University, China. Using a general questionnaire, we collected demographic, clinical and laboratory data. Medication literacy was assessed by the Chinese Medication Literacy Scale, and frailty was assessed by the FRAIL Scale. Univariate analyses examined potential factors associated with medication literacy. An ordered logistic regression was used to analyze the relationships between medication literacy and these factors. Spearman's correlation was used to assess the association between medication literacy and frailty. RESULTS A total of 290 MHD patients were included in the analysis. Inadequate, marginal, and adequate medication literacy was found in 56 (19.3%), 153 (52.8%), and 81 (27.9%) patients, respectively. Ordered logistic regression revealed factors associated with inadequate medication literacy: age (OR = 0.281, 95% CI = 0.139-0.565, p < 0.001 for < 65 years); education (OR = 8.612, 95% CI = 3.524-21.046, p < 0.001 for ≤ primary school education; OR = 3.405, 95% CI = 1.683-6.887, p = 0.001 for junior high school education); presence of caregiver medication assistance (OR = 2.302, 95% CI = 1.173-4.516, p = 0.015); frailty (OR = 0.440, 95% CI = 0.216-0.893, p = 0.023 for frail patients); and high β2-microglobulin (β2-MG) (OR = 1.010, 95% CI = 1.002-1.019, p = 0.012). Spearman's analysis showed that medication literacy was negatively correlated with frailty in MHD patients (R=-0.189, p = 0.001). CONCLUSIONS Medication literacy levels in MHD patients needed improvement and were associated with certain patient characteristics, including age, education level, presence of caregiver support, β2-microglobulin levels, and risk of frailty. This study identified subgroups of MHD patients, such as those who were older, had lower education, had caregiver assistance, had high β2-microglobulin levels, or were frail, to have inadequate medication literacy. These findings underscore the need for routine screening and targeted interventions to improve medication literacy in this population.
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Affiliation(s)
- Linfang Zhu
- Department of Nephrology, Kidney Research Institute, West China Hospital of Sichuan University, Chengdu, 610041, China
- West China School of Nursing, Sichuan University, Chengdu, 610041, China
| | - Yang Liu
- Department of Nephrology, Kidney Research Institute, West China Hospital of Sichuan University, Chengdu, 610041, China
- West China School of Nursing, Sichuan University, Chengdu, 610041, China
| | - Fengxue Yang
- Sichuan Nursing Vocational College, Chengdu, 610041, China
| | - Shaobin Yu
- Department of Nephrology, Kidney Research Institute, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Ping Fu
- Department of Nephrology, Kidney Research Institute, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Huaihong Yuan
- Department of Nephrology, Kidney Research Institute, West China Hospital of Sichuan University, Chengdu, 610041, China.
- West China School of Nursing, Sichuan University, Chengdu, 610041, China.
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Yildiz S, Heybeli C, Soysal P, Smith L, Veronese N, Kazancioglu R. Frequency and Clinical Impact of Anticholinergic Burden in older patients: Comparing older patients with and without chronic kidney disease. Arch Gerontol Geriatr 2023; 112:105041. [PMID: 37088015 DOI: 10.1016/j.archger.2023.105041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 04/16/2023] [Accepted: 04/18/2023] [Indexed: 04/25/2023]
Abstract
AIM This study aimed to determine the frequency and impact of anticholinergic burden in older adults with chronic kidney disease (CKD) and compare the results to older adults without CKD. METHOD Age- and sex-matched older adults (age ≥60) were selected from a total cohort of 1557 subjects, and grouped as CKD (n = 589) and Non-CKD (n = 589). Groups were compared for the frequency, type of anticholinergic agents, and their effects on comprehensive geriatric assessment parameters. The anticholinergic burden was assessed using the anticholinergic burden (ACB) scale. An ACB of ≥2 was categorized as high anticholinergic burden. RESULTS The mean age of the partients was 81±6, and 66% were female. More patients in the CKD group experienced a high anticholinergic burden (45%, versus 38%, p = 0.015). Patients with CKD were more likely to receive beta blocker (25% versus 19%, p = 0.018), diuretic (19% versus 6%, p<0.001), while those who did not have CKD were more likely to be treated with dopaminergic agents (8% versus 12%, p = 0.039). A high anticholinergic burden was associated with sarcopenia (OR 1.62, 95% CI 1.10-2.38, p = 0.015), geriatric depression scale (OR 1.50, 95% CI 1.02-2.20, p = 0.037), and polypharmacy (OR 4.05, 95% CI 2.38-6.90, p<0.001), after adjustment for age, sex and comorbidities in the CKD group (p<0.05). CONCLUSION Older patients with CKD are more likely to be exposed to drugs with anticholinergic effects, but have less clinical implications than those without CKD. A high anticholinergic burden is associated with polypharmacy, depression and sarcopenia in CKD.
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Affiliation(s)
- Serkan Yildiz
- Division of Nephrology, Medicana Hospital, Izmir, Turkey
| | - Cihan Heybeli
- Division of Nephrology, Mus State Hospital, Mus, Turkey
| | - Pinar Soysal
- Division of Geriatric Medicine, Faculty of Medicine, Bezmialem Vakif University, Adnan Menderes Bulvarı (Vatan Street), Fatih, Istanbul 34093, Turkey.
| | - Lee Smith
- Centre for Health, Performance, and Wellbeing, Anglia Ruskin University, Cambridge, UK
| | - Nicola Veronese
- Geriatric Unit, Department of Internal Medicine and Geriatrics, University of Palermo, Via del Vespro, 141, Palermo 90127, Italy
| | - Rumeyza Kazancioglu
- Division of Nephrology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
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Pereira-Céspedes A, Jiménez-Morales A, Palomares-Bayo M, Martínez-Martínez F, Calleja-Hernández MÁ. Medication Review with Follow-Up for End-Stage Renal Disease: Drug-Related Problems and Negative Outcomes Associated with Medication-A Systematic Review. J Clin Med 2023; 12:5080. [PMID: 37568483 PMCID: PMC10419351 DOI: 10.3390/jcm12155080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 07/24/2023] [Accepted: 07/29/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND This article reviews the available scientific literature on drug-related problems and negative outcomes associated with medications identified by medication review with follow-up for end-stage renal disease and discussed with the physicians. METHODS A systematic review was conducted of the scientific literature retrieved from the following databases: MEDLINE (via PubMed), Web of Science, SCOPUS, Cochrane Library: The Cochrane Central Register and Control Trials (CENTRAL) and Literatura Latinoamericana y del Caribe (LILACS), Medicina en Español (MEDES), and the SciELO bibliographic database (a collection of scientific journals). The following terms were used as descriptors and searched in free text: "end-stage renal disease", "medication review", "drug-related problems", and "negative outcomes associated with medication". The following limits were applied: "humans" and "adults (more than 18 years)". RESULTS A total of 59 references were recovered and, after applying inclusion/exclusion criteria, 16 articles were selected. Of these selected articles, 15 provided information on drug-related problems and only 1 on negative outcomes associated with medications. CONCLUSIONS It can be concluded that drug-related problems and negative outcomes associated with medications affect patients with end-stage renal disease, mainly those receiving renal replacement therapy. More evidence is needed, especially on negative outcomes associated with medication.
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Affiliation(s)
- Alfonso Pereira-Céspedes
- Pharmaceutical Care Research Group, Pharmacy Faculty, University of Granada, 18071 Granada, Spain; (A.J.-M.); (F.M.-M.); (M.Á.C.-H.)
- Pharmacy Department, Hospital Universitario Virgen de las Nieves, 18014 Granada, Spain
- Centro Nacional de Información de Medicamentos, Instituto de Investigaciones Farmacéuticas, Pharmacy Faculty, University of Costa Rica, San José 11501-2060, Costa Rica
- Nephrology Department, Hospital Universitario Virgen de las Nieves, 18014 Granada, Spain;
| | - Alberto Jiménez-Morales
- Pharmaceutical Care Research Group, Pharmacy Faculty, University of Granada, 18071 Granada, Spain; (A.J.-M.); (F.M.-M.); (M.Á.C.-H.)
- Pharmacy Department, Hospital Universitario Virgen de las Nieves, 18014 Granada, Spain
| | | | - Fernando Martínez-Martínez
- Pharmaceutical Care Research Group, Pharmacy Faculty, University of Granada, 18071 Granada, Spain; (A.J.-M.); (F.M.-M.); (M.Á.C.-H.)
| | - Miguel Ángel Calleja-Hernández
- Pharmaceutical Care Research Group, Pharmacy Faculty, University of Granada, 18071 Granada, Spain; (A.J.-M.); (F.M.-M.); (M.Á.C.-H.)
- Pharmacy Department, Hospital Universitario Virgen Macarena, 41009 Seville, Spain
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Salama L, Sica S, Cardone KE. Medicines for the Kidney. PHYSICIAN ASSISTANT CLINICS 2023. [DOI: 10.1016/j.cpha.2022.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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12
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Legesse ES, Muhammed OS, Hamza L, Nasir BB, Nedi T. Medication related problems among ambulatory patients with chronic kidney disease at St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia. PLoS One 2022; 17:e0278563. [PMID: 36455046 PMCID: PMC9714937 DOI: 10.1371/journal.pone.0278563] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 11/21/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Medication related problem (MRP) is an event occurring, as a result, the medication therapy that actually or potentially interferes with desired health outcomes. Evidences reported that the prevalence of MRPs may result in a high burden of morbidity and decrease patients' quality of life. The problem is more significant among patients with chronic kidney disease (CKD) as a decline in kidney function and increase number of medications required to treat kidney disease and its complications. Thus, this study aimed to assess MRPs and its associated factors among patients with chronic kidney disease. METHOD Hospital-based cross-sectional study was conducted among 248 adult ambulatory patients with CKD (stage 1-4) at St. Paul's Hospital Millennium Medical College. Data were collected through patient interview and medical chart review from 1st of June to 30th of August 2019. MRPs were identified based on the standard treatment guidelines. Cipolle MRPs classification was used to classify the MRPs and Micromedex® was used as drug interaction checker. Binary logistic regression was utilized to identify the associated factors and p value <0.05 was considered as statistically significant. RESULT A total of 325 MRPs were identified from 204 (82.3%) study participants giving 1.6 MRPs per participant. One MRP was identified among 114 (55.9%) patients while two MRPs were identified among 64 (31.4%). The most common class of MRPs were need additional drugs 114 (35.1%) followed by non-compliance 54 (16.6%), unnecessary drug therapy 46 (14.2%) and dose too low 46 (14.2%). The two most common reasons for non-compliance were unaffordability of drugs 26(48.1%) and the lack of patient understanding about drug taking instruction 10 (18.5%). The study showed that only occupation (AOR = 5.2, 95% CI: 1.292-21.288, P = 0.020) and angiotensin converting enzyme inhibitor use (AOR = 6.6, 95% CI: 2.202-19.634, P = 0.001) had an association with the occurrence of MRPs. CONCLUSION The prevalence of MRPs among ambulatory patients with CKD was high and need of additional drug therapy was the commonest MRPs.
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Affiliation(s)
| | - Oumer Sada Muhammed
- Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Leja Hamza
- St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Beshir Bedru Nasir
- Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Teshome Nedi
- Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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13
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Principles for the Prevention of Medication-Induced Nephrotoxicity. Crit Care Nurs Clin North Am 2022; 34:361-371. [DOI: 10.1016/j.cnc.2022.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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14
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Schettler V, Schlieper G. Gerinnungsmanagement in der schweren, fortgeschrittenen Niereninsuffizienz. AKTUELLE KARDIOLOGIE 2022. [DOI: 10.1055/a-1949-8104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
ZusammenfassungPatienten mit chronischer Niereninsuffizienz (CKD) haben ein hohes Risiko für nicht valvuläres Vorhofflimmern (NVAF) und häufig ein höheres Risiko für venöse Thromboembolien (VTE) aufgrund
ihrer Grunderkrankungen wie z. B. Diabetes. Bisher kamen Vitamin-K-Antagonisten (VKA) auch bei diesen Patienten in Deutschland zum Einsatz. VKA haben ein erhöhtes Blutungsrisiko und werden
als Risikofaktor für eine Verschlechterung der Nierenfunktion und/oder Gefäßsituation (Athero- und Mediasklerose) von Patienten diskutiert. Aus diesen Gründen und den vorliegenden
Studiendaten werden deshalb direkt wirkende orale Antikoagulanzien (DOAC) auch bei Patienten mit NVAF und CKD (G1–G3) in den Leitlinien empfohlen. Allerdings kann keine klare Empfehlung für
den Einsatz von DOAC bei Dialysepatienten gegeben werden. Heparine spielen in diesem Zusammenhang nur eine untergeordnete Rolle.
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Affiliation(s)
| | - Georg Schlieper
- Zentrum für Nieren-, Hochdruck- und Stoffwechselerkrankungen, Hannover, Deutschland
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15
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Nkunu V, Wiebe N, Bello A, Campbell S, Tannor E, Varghese C, Stanifer J, Tonelli M. Update on Existing Care Models for Chronic Kidney Disease in Low- and Middle-Income Countries: A Systematic Review. Can J Kidney Health Dis 2022; 9:20543581221077505. [PMID: 35251672 PMCID: PMC8894943 DOI: 10.1177/20543581221077505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 11/28/2021] [Indexed: 11/24/2022] Open
Abstract
Background: Approximately 78% of chronic kidney disease (CKD) cases reside in low- and middle-income countries (LMICs). However, little is known about the care models for CKD in LMICs. Objective: Our objective was to update a prior systematic review on CKD care models in LMICs and summarize information on multidisciplinary care and management of CKD complications. Design: We searched MEDLINE, EMBASE, and Global Health databases in September 2020, for papers published between January 1, 2017, and September 14, 2020. We used a combination of search terms, which were different iterations of CKD, care models, and LMICs. The World Bank definition (2019) was used to identify LMICs. Setting: Our review included studies published in LMICs across 4 continents: Africa, Asia, North America (Mexico), and Europe (Ukraine). The study settings included tertiary hospitals (n = 6), multidisciplinary clinics (n = 1), primary health centers (n = 2), referral centers (n = 2), district hospitals (n = 1), teaching hospitals (n = 1), regional hospital (n = 1), and an urban medical center (n = 1). Patients: Eighteen studies met inclusion criteria, and encompassed 4679 patients, of which 4665 were adults. Only 9 studies reported mean eGFR which ranged from 7 to 45.90 ml/min/1.73 m2. Measurements: We retrieved the following details about CKD care: funding, urban or rural location, types of health care staff, and type of care provided, as defined by Kidney Disease Improving Global Outcomes (KDIGO) guidelines for CKD care. Methods: We included studies which met the following criteria: (1) population was largely adults, defined as age 18 years and older; (2) most of the study population had CKD, and not end-stage kidney disease (ESKD); (3) population resided in an LMIC as defined by the World Bank; (4) manuscript described in some detail a clinical care model for CKD; (5) manuscript was in either English or French. Animal studies, case reports, comments, and editorials were excluded. Results: Eighteen studies (24 care models with 4665 patients) met inclusion criteria. Out of 24 care models, 20 involved interdisciplinary health care teams. Twenty models incorporated international guidelines for CKD management. However, conservative kidney management (management of kidney failure without dialysis or renal transplant) was in a minority of models (11 of 24). Although there were similarities between all the clinical care models, there was variation in services provided and in funding arrangement; the latter ranged from comprehensive government funding (eg, Sri Lanka, Thailand), to out-of-pocket payments (eg, Benin, Togo). Limitations: These include (1) lack of detail on CKD care in many of the studies, (2) small number of included studies, (3) using a different definition of care model from the original Stanifer et al paper, and (4) using the KDIGO Guidelines as the standard for defining a CKD care model. Conclusions: Most of the CKD models of care include the key elements of CKD care. However, access to such care depends on the funding mechanism available. In addition, few models included conservative kidney management, which should be a priority for future investment. Trial registration: Not applicable.
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Affiliation(s)
- Victoria Nkunu
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Natasha Wiebe
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Aminu Bello
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Sandra Campbell
- John W. Scott Health Sciences Library, University of Alberta, Edmonton, Canada
| | - Elliot Tannor
- Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Cherian Varghese
- Department of Noncommunicable Diseases, World Health Organization, Geneva, Switzerland
| | - John Stanifer
- Department of Medicine, Duke University, Durham, NC, USA
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Butrovich MA, Tang W, Boulton DW, Nolin TD, Sharma P. Use of Physiologically Based Pharmacokinetic Modeling to Evaluate the Impact of Chronic Kidney Disease on CYP3A4-Mediated Metabolism of Saxagliptin. J Clin Pharmacol 2022; 62:1018-1029. [PMID: 35247279 PMCID: PMC9545133 DOI: 10.1002/jcph.2043] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 02/25/2022] [Indexed: 11/25/2022]
Abstract
We characterized the impact of chronic kidney disease (CKD) on the cytochrome P450 (CYP) 3A4–mediated metabolism of saxagliptin to its metabolite, 5‐hydroxysaxagliptin, using a physiologically based pharmacokinetic (PBPK) model. A PBPK model of saxagliptin and its CYP3A4 metabolite, 5‐hydroxysaxagliptin, was constructed and validated for oral doses ranging from 5 to 100 mg. The observed ratios of area under the plasma concentration–time curve (AUC) and maximum plasma concentration (Cmax) between healthy subjects and subjects with CKD were compared with those predicted using PBPK model simulations. Simulations were performed with virtual CKD populations having decreased CYP3A4 activity (ie, 64%‐75% of the healthy subjects’ CYP3A4 abundance) and preserved CYP3A4 activity (ie, 100% of the healthy subjects’ CYP3A4 abundance). We found that simulations using decreased CYP3A4 activity generally overpredicted the ratios of saxagliptin AUC and Cmax in CKD compared with those using preserved CYP3A4 activity. Similarly, simulations using decreased CYP3A4 activity underpredicted the ratio of 5‐hydroxysaxagliptin AUC in moderate and severe CKD compared with simulations using preserved CYP3A4 activity. These findings suggest that decreased CYP3A4 activity in CKD underpredicts saxagliptin clearance compared with that observed clinically. Preserving CYP3A4 activity in CKD more closely estimates saxagliptin clearance and 5‐hydroxysaxagliptin exposure changes observed in vivo. Our findings suggest that there is no clinically meaningful impact of CKD on the metabolism of saxagliptin by CYP3A4. Since saxagliptin is not a highly sensitive substrate and validated probe for CYP3A4, this work represents a case study of a CYP3A4 substrate‐metabolite pair and is not a generalization for all CYP3A4 substrates.
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Affiliation(s)
- Morgan A. Butrovich
- Department of Pharmacy and TherapeuticsUniversity of Pittsburgh School of PharmacyPittsburghPennsylvaniaUSA
| | - Weifeng Tang
- Clinical Pharmacology and Quantitative PharmacologyClinical Pharmacology and Safety Sciences, R&D, AstraZenecaGaithersburgMarylandUSA
| | - David W. Boulton
- Clinical Pharmacology and Quantitative PharmacologyClinical Pharmacology and Safety Sciences, R&D, AstraZenecaGaithersburgMarylandUSA
| | - Thomas D. Nolin
- Department of Pharmacy and TherapeuticsUniversity of Pittsburgh School of PharmacyPittsburghPennsylvaniaUSA
| | - Pradeep Sharma
- Clinical Pharmacology and Quantitative PharmacologyClinical Pharmacology and Safety Sciences, R&D, AstraZenecaCambridgeUK
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Prasad N, Yadav AK, Kundu M, Sethi J, Jaryal A, Sircar D, Modi GK, Kamboj K, Sahay M, Gopalakrishnan N, Kaur P, Vikrant S, Varughese S, Baid-Agrawal S, Singh S, Gang S, Parameswaran S, Kumar V, Ghosh A, Jha V. Prescription Practices in Patients With Mild to Moderate CKD in India. Kidney Int Rep 2021; 6:2455-2462. [PMID: 34514206 PMCID: PMC8418981 DOI: 10.1016/j.ekir.2021.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 06/12/2021] [Accepted: 06/14/2021] [Indexed: 11/29/2022] Open
Abstract
Introduction Patients with chronic kidney disease (CKD) require multiple medications. There is no information on prescription patterns or the use of evidence-based therapies for management of CKD from low-middle-income countries. Using baseline data from the Indian CKD (ICKD) cohort, we describe the drug prescription practices in patients with mild to moderate CKD. Methods The ICKD study is a prospective, observational cohort study of mild to moderate kidney disease across 11 centers in India. We analyzed all the prescriptions captured at enrollment in the ICKD study. Drugs were categorized into 11 different groups. We provide descriptive data on prescription details and evaluate the appropriateness of medication use. Results Complete prescription data were available in 3966 out of 4056 (97.8%) subjects enrolled in the ICKD database. Most patients had stage 3 CKD, 24.9% had diabetic kidney disease, 87% had hypertension, and 25.5% had moderate to severe proteinuria. Renin-angiotensin-aldosterone system blockers were prescribed in less than half (47.9%) and in 58.8% of patients with proteinuric CKD. Metformin was prescribed in 25.7% of diabetic subjects with CKD. Only 40.4% of patients were taking statins; 31.1% and 2.8% subjects with anemia were receiving iron and erythropoiesis-stimulating agents, respectively. Conclusion This study highlights the missed opportunities for improving outcomes through appropriate prescriptions of drugs in patients with CKD. There is need for dissemination of evidence-based guidelines and institution of sustainable implementation practices for improving the overall health of patients with CKD.
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Affiliation(s)
- Narayan Prasad
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Science, Lucknow, India
| | - Ashok Kumar Yadav
- Department of Experimental Medicine and Biotechnology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Monica Kundu
- George Institute for Global Health India, New Delhi, India
| | - Jasmin Sethi
- Department of Nephrology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ajay Jaryal
- Department of Nephrology, Indira Gandhi Medical College, Shimla, India
| | - Dipankar Sircar
- Department of Nephrology Institute of Post Graduate Medical Education and Research, Kolkata, India
| | - Gopesh K. Modi
- Samarpan Kidney Institute and Research Center, Bhopal, India
| | - Kajal Kamboj
- Department of Nephrology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Manisha Sahay
- Department of Nephrology, Osmania Medical College, Osmania General Hospital, Hyderabad, India
| | | | - Prabhjot Kaur
- Department of Nephrology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sanjay Vikrant
- Department of Nephrology, Indira Gandhi Medical College, Shimla, India
| | | | - Seema Baid-Agrawal
- Department of Nephrology and Transplant Center, Sahlgrenska University Hospital, University of Gothenburg, Sweden
| | - Shivendra Singh
- Department of Nephrology, Institute of Medical Science, Banaras Hindu University, Varanasi, India
| | - Sishir Gang
- Department of Nephrology, Muljibhai Patel Urological Hospital, Nadiad, India
| | - Sreejith Parameswaran
- Department of Nephrology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
| | - Vivek Kumar
- Department of Nephrology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Arpita Ghosh
- George Institute for Global Health India, New Delhi, India
| | - Vivekanand Jha
- George Institute for Global Health India, New Delhi, India
- School of Public Health, Imperial College, London, UK
- Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
- Correspondence: Vivekanand Jha, Executive Director, The George Institute for Global Health India; 311-312, Third Floor, Elegance Tower, Plot No. 8, Jasola District Centre, New Delhi 110025, India.
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Susilawati NM, Halimah E, Saidah S. Pharmacists’ strategies to detect, resolve, and prevent DRPs in CKD patients. PHARMACIA 2021. [DOI: 10.3897/pharmacia.68.e65136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Pharmacists have undergone obstacles in the process of detecting, resolving, and preventing CKD patients’ DRPs. Thus, optimal strategies were needed. A total of 19 articles were included based on the article searching process. Based on the articles, it can be concluded: The strategies of detecting DRPs in CKD patients were carried out through medication reconciliation and medication review. The outcomes of these strategies were the number of DRPs/patients and types of DRPs detected. Strategies to resolve and prevent DRPs in CKD patients were conducted through interprofessional collaboration, education, and counselling. The outcome of these strategies was a change in the patients’ DRPs status. Optimization of detection, resolution, and prevention strategies were performed by improving pharmacists’ professional hard and soft-skills as well as modifying the pharmaceutical care delivery model. A decrease in the number of DRPs/patients and a change in DRPs status were reported as the outcomes of optimizing this process.
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Mohottige D, Manley HJ, Hall RK. Less is More: Deprescribing Medications in Older Adults with Kidney Disease: A Review. KIDNEY360 2021; 2:1510-1522. [PMID: 35373095 PMCID: PMC8786141 DOI: 10.34067/kid.0001942021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 07/08/2021] [Indexed: 02/04/2023]
Abstract
Due to age and impaired kidney function, older adults with kidney disease are at increased risk of medication-related problems and related hospitalizations. One proa ctive approach to minimize this risk is deprescribing. Deprescribing refers to the systematic process of reducing or stopping a medication. Aside from preventing harm, deprescribing can potentially optimize patients' quality of life by aligning medications with their goals of care. For some patients, deprescribing could involve less aggressive management of their diabetes and/or hypertension. In other instances, deprescribing targets may include potentially inappropriate medications that carry greater risk of harm than benefit in older adults, medications that have questionable efficacy, including medications that have varying efficacy by degree of kidney function, and that increase medication regimen complexity. We include a guide for clinicians to utilize in deprescribing, the List, Evaluate, Shared Decision-Making, Support (LESS) framework. The LESS framework provides key considerations at each step of the deprescribing process that can be tailored for the medications and context of individu al patients. Patient characteristics or clinical events that warrant consideration of deprescribing include limited life expectancy, cognitive impairment, and health status changes, such as dialysis initiation or recent hospitalization. We acknowledge patient-, clinician-, and system-level challenges to the depre scribing process. These include patient hesitancy and challenges to discussing goals of care, clinician time constraints and a lack of evidence-based guidelines, and system-level challenges of interoperable electronic health records and limited incentives for deprescribing. However, novel evidence-based tools designed to facilitate deprescribing and future evidence on effectiveness of deprescribing could help mitigate these barriers. This review provides foundational knowledge on deprescribing as an emerging component of clinical practice and research within nephrology.
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Affiliation(s)
- Dinushika Mohottige
- Renal Section, Durham Veterans Affairs Healthcare System, Durham, North Carolina,Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | | | - Rasheeda K. Hall
- Renal Section, Durham Veterans Affairs Healthcare System, Durham, North Carolina,Department of Medicine, Duke University School of Medicine, Durham, North Carolina
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20
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Awoke M, Melaku T, Beshir M. Drug-related problems and its determinant among hospitalized neonates with sepsis at Jimma University Medical Center, Ethiopia: a prospective observational study. J Pharm Health Care Sci 2021; 7:20. [PMID: 34059150 PMCID: PMC8168002 DOI: 10.1186/s40780-021-00203-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 03/16/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Neonatal populations are quite susceptible to drug-related problems (DRPs) because of clinical heterogeneity and clinical practice trends. However, studies reporting DRPs in the neonatal population are quite limited. OBJECTIVE This study aimed to assess the magnitude and types of DRPs and determinant factors among neonates admitted with neonatal sepsis at the Neonatal Intensive Care Unit (NICU) of the Jimma University Medical Center (JUMC), Ethiopia. METHODS A hospital-based prospective observational study was conducted involving 201 neonates with sepsis admitted to the NICU from May to August 30, 2018. DRPs were classified using Cipolle's classification method. Statistical Package for Social Science Version 22 was employed for data analysis. Logistical regression was carried out to determine the determinants of DRPs. A p-value < 0.05 was considered to be statistically significant. RESULTS Of 201 neonates with sepsis included in this study, 125 (62.2%) were males and the median age of the neonate was 5 days. The mean (±standard deviation) number of medications taking during their hospital stay was 2.6 ± 0.7. DRPs were identified in 98 neonates, at a rate of 48.8% (95% CI, 41.7-55.9). Dose too high (42, 35.8%) and need additional drug therapy (40, 34.1%) were the commonly identified DRPs. Taking antibiotics plus other medications (Adjusted Odds Ratio (AOR) =5.2, 95%CI [1.2-22.0], p = 0.02) was a determinant factor for the occurrence of DRPs. CONCLUSION The burdens of DRPs occurrence were high in hospitalized neonates with sepsis. The most common DRPs identified were dose too high and need additional drug therapy. Combined use of other medicines with antibiotics was a predictor of DRP occurrence. The innovative way to tackle the occurrence of DRPs, such as the incorporation of clinical pharmacy service provider into the neonatal care team, which will prevent, detect and/or minimize the occurrence of DRPs, is highly recommended.
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Affiliation(s)
- Mengist Awoke
- Department of Clinical Pharmacy, School of Pharmacy, Institute of Health, Jimma University, PO. Box 378, Jimma, Ethiopia.
| | - Tsegaye Melaku
- Department of Clinical Pharmacy, School of Pharmacy, Institute of Health, Jimma University, PO. Box 378, Jimma, Ethiopia
| | - Mohammed Beshir
- Department of Pediatrics, Jimma University Medical Center, PO. Box 378, Jimma, Ethiopia
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21
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Codd C, Martinusen D, Cardone KE, Cho K, Pai AB. Preparing for implementation of a medication reconciliation measure for dialysis: Expanding the role of pharmacy technicians. Am J Health Syst Pharm 2021; 77:892-896. [PMID: 32426840 DOI: 10.1093/ajhp/zxaa077] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | | | | | - Katherine Cho
- University of Michigan College of Pharmacy, Ann Arbor, MI
| | - Amy Barton Pai
- University of Michigan College of Pharmacy, Ann Arbor, MI
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Kakar A, Mouelhi Y, Loundou A, Crémades A, Gentile S. Comorbidity Profiles among Obese-Diabetic End-Stage Renal Disease Patients: Data from REIN Registry of PACA Region of France. Diabetes Metab Syndr Obes 2021; 14:617-625. [PMID: 33603426 PMCID: PMC7884933 DOI: 10.2147/dmso.s291343] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 01/16/2021] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION The proportion of new dialysis patients with comorbidities increased by an average of 5.6% per year in the Provence-Alpes-Côte d'Azur (PACA) region, with major increases in obese, cancer, and diabetic patients. This study aimed to describe comorbidity profiles among obese-diabetic end-stage renal disease (ESRD) patients in the Renal Epidemiology and Information Network (REIN) registry of the PACA region of France on December 31, 2018. METHODS Data for this retrospective cross-sectional study were retrieved from the REIN registry of the PACA region. Data were analyzed using two models. Firstly, the ESRD patients were divided into two groups and binary logistic regression model used for the analysis of the data. Secondly, ESRD patients were divided into four groups and multinomial logistic regression model used. Univariate analysis was performed for group comparison using x2 and t-tests, while binary logistic and multinomial logistic regression models were used for multivariate analysis to derive ORs and 95% CIs. RESULTS Among the 4,491 ESRD patients in this study, 623 were obese-diabetic and 3,868 nonobese-nondiabetic and obese only/ diabetic only. Obese-diabetic ESRD patients were younger (<75 years, OR 0.46, p<0.001), smoked less (OR 0.51, p<0.001), were mainly dialyzed at centers (OR 1.29, p=0.014), and less likely to be on the renal transplant waiting list (OR 0.46, p<0.001) compared to the other group. Obese-diabetic ESRD patients also had more comorbidities, including cardiovascular diseases (OR 1.38, p=0.028), coronary insufficiency (OR 1.49, p=0.001) and chronic obstructive pulmonary disease (OR 1.75, p<0.001), but had fewer cases of cancer (OR 0.68, p=0.024) compare to the other group. CONCLUSION Obese-diabetic patients with ESRD have many specific characteristics. These patients were younger, but had more cardiovascular comorbidities and were less likely to be on the waiting list for transplantation. They should receive special attention and be the subject of prevention and therapeutic education.
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Affiliation(s)
- Asmatullah Kakar
- Aix Marseille University School of Medicine — La Timone Medical Campus, EA 3279: CEReSS — Health Service Research and Quality of Life Center, Marseille, France
- Correspondence: Asmatullah Kakar Aix Marseille University School of Medicine — La Timone Medical Campus, EA 3279: CEReSS — Health Service Research and Quality of Life Center, 27 Boulevard Jean Moulin, Marseille, 13005, FranceTel +33-4 9132 4470Fax +33(0)4 91 38 44 82 Email
| | - Yosra Mouelhi
- Aix Marseille University School of Medicine — La Timone Medical Campus, EA 3279: CEReSS — Health Service Research and Quality of Life Center, Marseille, France
| | - Anderson Loundou
- Aix Marseille University School of Medicine — La Timone Medical Campus, EA 3279: CEReSS — Health Service Research and Quality of Life Center, Marseille, France
| | - Adeline Crémades
- Aix Marseille University School of Medicine — La Timone Medical Campus, EA 3279: CEReSS — Health Service Research and Quality of Life Center, Marseille, France
| | - Stephanie Gentile
- Aix Marseille University School of Medicine — La Timone Medical Campus, EA 3279: CEReSS — Health Service Research and Quality of Life Center, Marseille, France
- Assistance Publique, Hôpitaux de Marseille (AP-HM), Marseille, France
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Jang SM, Parker WM, Pai AB, Jiang R, Cardone KE. Assessment of literacy and numeracy skills related to medication labels in patients on chronic in-center hemodialysis. J Am Pharm Assoc (2003) 2020; 60:957-962.e1. [DOI: 10.1016/j.japh.2020.07.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 06/09/2020] [Accepted: 07/09/2020] [Indexed: 11/16/2022]
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24
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Marquito AB, Pinheiro HS, Paula RBD. [Cross-cultural adaptation of the PAIR instrument: Pharmacotherapy Assessment in Chronic Renal Disease for application in Brazil]. CIENCIA & SAUDE COLETIVA 2020; 25:4021-4032. [PMID: 32997033 DOI: 10.1590/1413-812320202510.35522018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 02/09/2019] [Indexed: 11/22/2022] Open
Abstract
Individuals suffering from chronic kidney disease (CKD) are often on multiple medications, which exposes them to drug-related problems (DRP). There are no available tools in Brazil to assess the pharmacotherapy and management of DRPs systematically in this population. The scope of this study was to perform a cross-cultural adaptation of PAIR criteria (Pharmacotherapy Assessment in Chronic Renal Disease) to Brazilian Portuguese. PAIR criteria consist of 50 DRP clinically significant items for CKD. The process of cross-cultural adaptation involved translation, synthesis, back-translation, and an analysis by an expert committee as well as a pre-test of the first draft document. A review committee consisting of 2 pharmacists and 2 nephrologists analyzed the semantic, linguistic, experiential, and conceptual equivalence between the original and translated versions. All items that obtained a score below 80% were reviewed. Word adjustments were made, as well as the exclusion of 6 DRP due to non-applicability to the Brazilian context. Thus, the final version of PAIR defined as "Avaliação da farmacoterapia na doença renal crônica" was translated and adapted into the Brazilian Portuguese language.
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Affiliation(s)
- Alessandra Batista Marquito
- Núcleo Interdisciplinar de Estudos, Pesquisas e Tratamento em Nefrologia, Universidade Federal de Juiz de Fora (UFJF). R. José Lourenço Kelmer 1300, Centro Comercial, Bairro São Pedro. 36036-330 Juiz de Fora MG Brasil.
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Marquito AB, Pinheiro HS, Fernandes NMDS, de Paula RB. Pharmacotherapy assessment in chronic kidney disease: validation of the PAIR instrument for use in Brazil. J Bras Nefrol 2020; 42:400-412. [PMID: 32495815 PMCID: PMC7860645 DOI: 10.1590/2175-8239-jbn-2019-0205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 04/01/2020] [Indexed: 11/29/2022] Open
Abstract
Individuals with chronic kidney disease (CKD) use polypharmacy, which, in combination with renal impairment, exposes them to the risk of drug-related problems (DRPs). There are no available tools in Brazil to systematically assess the pharmacotherapy and management of DRPs in this population. Therefore, the objective of this work was to validate the PAIR instrument (Pharmacotherapy Assessment in Chronic Renal Disease) for use in Brazilian Portuguese. This is a retrospective longitudinal observational study. Medical records from 100 CKD patients under conservative treatment, between 2016 and 2017, in a nephrology clinic, were analyzed. PAIR was applied by pharmacists in two consultations of the same patient, with an interval of 6 months. Reliability, conceptual validity, responsiveness of the instrument and prevalence of DRPs in the studied sample were assessed. A mean of 1.26 ± 0.96 DRPs/patient was identified. Inter-rater reliability coefficients (k) ranged from 0.58 to 0.94 and from 0.79 to 1.00 for test-retest, revealing moderate to perfect level of agreement. In conceptual validity, a mean of 1.60 ± 1.24 DRPs/patient was identified by the nephrologist through clinical judgment, compared to 1.33±0.76 DRPs/patient identified by the pharmacist using PAIR (p = 0.07). Therefore PAIR allowed the identification of clinically significant DRPs. In responsiveness, a mean of 1.26 ± 0.96 DRPs/patient was identified at the first consultation and 1.11 ± 1.02 DRPs/patient at the subsequent consultation (p = 0.17) by the pharmacist using PAIR. The number of DRPs between the periods did not change. As a conclusion, the PAIR allowed the identification of clinically significant DRPs in CKD, constituting a new validated instrument to be used in Brazil.
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Affiliation(s)
- Alessandra Batista Marquito
- Universidade Federal de Juiz de Fora, Faculdade de Medicina, Programa de Pós-Graduação em Saúde, Núcleo Interdisciplinar de Estudos, Pesquisas e Tratamento em Nefrologia, Juiz de Fora, MG, Brasil
| | - Hélady Sanders Pinheiro
- Universidade Federal de Juiz de Fora, Faculdade de Medicina, Programa de Pós-Graduação em Saúde, Núcleo Interdisciplinar de Estudos, Pesquisas e Tratamento em Nefrologia, Juiz de Fora, MG, Brasil
- Universidade Federal de Juiz de Fora, Faculdade de Medicina, Departamento de Clínica Médica, Juiz de Fora, MG, Brasil. Núcleo Interdisciplinar de Estudos, Pesquisas e Tratamento em Nefrologia, Juiz de Fora, MG, Brasil
| | - Natália Maria da Silva Fernandes
- Universidade Federal de Juiz de Fora, Faculdade de Medicina, Programa de Pós-Graduação em Saúde, Núcleo Interdisciplinar de Estudos, Pesquisas e Tratamento em Nefrologia, Juiz de Fora, MG, Brasil
- Universidade Federal de Juiz de Fora, Faculdade de Medicina, Departamento de Clínica Médica, Juiz de Fora, MG, Brasil. Núcleo Interdisciplinar de Estudos, Pesquisas e Tratamento em Nefrologia, Juiz de Fora, MG, Brasil
| | - Rogério Baumgratz de Paula
- Universidade Federal de Juiz de Fora, Faculdade de Medicina, Programa de Pós-Graduação em Saúde, Núcleo Interdisciplinar de Estudos, Pesquisas e Tratamento em Nefrologia, Juiz de Fora, MG, Brasil
- Universidade Federal de Juiz de Fora, Faculdade de Medicina, Departamento de Clínica Médica, Juiz de Fora, MG, Brasil. Núcleo Interdisciplinar de Estudos, Pesquisas e Tratamento em Nefrologia, Juiz de Fora, MG, Brasil
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Schijvens AM, de Wildt SN, Schreuder MF. Pharmacokinetics in children with chronic kidney disease. Pediatr Nephrol 2020; 35:1153-1172. [PMID: 31375913 PMCID: PMC7248054 DOI: 10.1007/s00467-019-04304-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 06/26/2019] [Accepted: 07/02/2019] [Indexed: 12/20/2022]
Abstract
In children, the main causes of chronic kidney disease (CKD) are congenital diseases and glomerular disorders. CKD is associated with multiple physiological changes and may therefore influence various pharmacokinetic (PK) parameters. A well-known consequence of CKD on pharmacokinetics is a reduction in renal clearance due to a decrease in the glomerular filtration rate. The impact of renal impairment on pharmacokinetics is, however, not limited to a decreased elimination of drugs excreted by the kidney. In fact, renal dysfunction may lead to modifications in absorption, distribution, transport, and metabolism as well. Currently, insufficient evidence is available to guide dosing decisions on many commonly used drugs. Moreover, the impact of maturation on drug disposition and action should be taken into account when selecting and dosing drugs in the pediatric population. Clinicians should take PK changes into consideration when selecting and dosing drugs in pediatric CKD patients in order to avoid toxicity and increase efficiency of drugs in this population. The aim of this review is to summarize known PK changes in relation to CKD and to extrapolate available knowledge to the pediatric CKD population to provide guidance for clinical practice.
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Affiliation(s)
- Anne M Schijvens
- Radboud Institute for Molecular Life Sciences, Department of Pediatric Nephrology, Radboud University Medical Center, Amalia Children's Hospital, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.
| | - Saskia N de Wildt
- Department of Pharmacology and Toxicology, Radboud University Medical Center, Nijmegen, The Netherlands
- Intensive Care and Department of Pediatric Surgery, Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Michiel F Schreuder
- Radboud Institute for Molecular Life Sciences, Department of Pediatric Nephrology, Radboud University Medical Center, Amalia Children's Hospital, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
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Fam JM, Khoo CY, Lau YH, Lye WK, Cai XJ, Choong LHL, Allen JC, Yeo KK. Age and diabetes mellitus associated with worse outcomes after percutaneous coronary intervention in a multi-ethnic Asian dialysis patient population. Singapore Med J 2020; 62:300-304. [PMID: 32179924 DOI: 10.11622/smedj.2020025] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
INTRODUCTION There is limited literature on clinical outcomes following percutaneous coronary intervention (PCI) in Asian dialysis patients. We evaluated the angiographic characteristics and clinical outcomes of dialysis patients treated with PCI in an Asian society. METHODS A retrospective analysis was performed of 274 dialysis patients who underwent PCI in a tertiary care institution from January 2007 to December 2012. Data on clinical and angiographic characteristics was collected. The primary endpoint was major adverse cardiac events (MACE), defined as a composite of cardiac death, acute myocardial infarction (AMI) and stroke at two years. RESULTS 274 patients (65.0% male, median age 62.0 years) with 336 lesions (81.8% Type B2) were treated. 431 stents (35.0% drug-eluting stents) with a mean diameter of 2.96 mm and mean length of 21.30 mm were implanted. The MACE rate was 55.8% (n = 153) at two years, from death (36.5%) and AMI (35.0%). In multivariable analysis, age and diabetes mellitus were significant predictors of both mortality (odds ratio [OR] 1.09, 95% confidence interval [CI] 1.05-1.12, p < 0.001; OR 2.65, 95% CI 1.46-4.82, p = 0.001, respectively) and MACE (OR 1.06, 95% CI 1.03-1.08, p < 0.001; OR 1.84, 95% CI 1.07-3.15, p = 0.027, respectively). Left ventricular ejection fraction (LVEF) (OR 0.97, 95% CI 0.95-0.99, p = 0.006) was a significant predictor of mortality but not MACE. CONCLUSION Asian dialysis patients who underwent PCI had a two-year MACE rate of 55.8% due to death and AMI. Age, LVEF and diabetes mellitus were significant predictors of mortality at two years.
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Affiliation(s)
- Jiang Ming Fam
- Department of Cardiology, National Heart Centre Singapore, Singapore
| | - Chun Yuan Khoo
- Department of Cardiology, National Heart Centre Singapore, Singapore
| | - Yee How Lau
- Department of Cardiology, National Heart Centre Singapore, Singapore
| | | | - Xinzhe James Cai
- Department of Cardiology, National Heart Centre Singapore, Singapore
| | | | | | - Khung Keong Yeo
- Department of Cardiology, National Heart Centre Singapore, Singapore
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Busari AA, Oreagba IA, Oshikoya KA, Kayode MO, Olayemi SO. High Risk of Drug-drug interactions among Hospitalized Patients with kidney Diseases at a Nigerian Teaching Hospital: A Call for Action. Niger Med J 2020; 60:317-325. [PMID: 32180663 PMCID: PMC7053273 DOI: 10.4103/nmj.nmj_2_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 06/19/2019] [Accepted: 09/13/2019] [Indexed: 11/04/2022] Open
Abstract
Background Potential drug-drug interactions (DDIs) are increasingly common in clinical practice, especially among individuals with chronic conditions, such as chronic kidney dysfunction. However, data relating to DDIs among chronically ill patients are limited in Nigeria. We, therefore, investigated the prevalence and pattern of DDIs among patients with kidney diseases on admission at a tertiary hospital in Lagos, Nigeria. Materials and Methods This was a prospective observational study involving 61 adults with kidney diseases and on admission in medical wards of the study center, over a 3-month period. Data extractions were with a purposefully designed pro forma to extract relevant data on demographic, clinical, and dosing regimens of the prescribed drugs for individual patients. Potential DDIs were identified, and their severity was rated using the MICROMEDEX® software database (IBM® Watson-Truven Health Analytics), which is available online with limited access. Results Of the 61 patients evaluated, majority were males (34; 55.7%), were elderly (26; 42.6%), and had chronic kidney disease Stage 3 (40; 65.5%). The most common cause of kidney disease was hypertension (20; 32.8%). Out of the 542 prescriptions received by the patients, potential DDI was observed in 508 (93.7%) prescriptions. Clinically significant drug interactions (CSDIs) were detected in 486 (85.7%) prescriptions. Pharmacodynamic DDIs (466; 91.7%) were the most common. Pill burden exceeding 25 pills/day was present in nine (14.8%) patients. The severities of the potential DDIs were major (135; 24.9%), moderate (333; 61.4%), and minor (38; 7.1%). Only two different potential DDIs were rated X (contraindicated). Conclusion Exposure to drugs with potential DDIs was very common among patients with kidney diseases. Most of the CSDIs observed were of major severity. The use of DDI checker before prescribing drugs for individuals with kidney diseases could avert clinically significant interactions.
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Affiliation(s)
- Abdulwasiu Adeniyi Busari
- Department of Pharmacology, Therapeutics and Toxicology, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Ibrahim A Oreagba
- Department of Pharmacology, Therapeutics and Toxicology, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Kazeem A Oshikoya
- Department of Pharmacology, Therapeutics and Toxicology, Lagos State University College of Medicine, Ikeja, Lagos, Nigeria
| | - Mary O Kayode
- Department of Pharmacology, Therapeutics and Toxicology, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Sunday O Olayemi
- Department of Pharmacology, Therapeutics and Toxicology, College of Medicine, University of Lagos, Lagos, Nigeria
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Roux-Marson C, Baranski JB, Fafin C, Exterman G, Vigneau C, Couchoud C, Moranne O, Investigators PSPA. Medication burden and inappropriate prescription risk among elderly with advanced chronic kidney disease. BMC Geriatr 2020; 20:87. [PMID: 32131742 PMCID: PMC7057617 DOI: 10.1186/s12877-020-1485-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 02/20/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Elderly patients with chronic kidney disease (CKD) frequently present comorbidities that put them at risk of polypharmacy and medication-related problems. This study aims to describe the overall medication profile of patients aged ≥75 years with advanced CKD from a multicenter French study and specifically the renally (RIMs) and potentially inappropriate-for-the-elderly medications (PIMs) that they take. METHODS This is a cross-sectional analysis of medication profiles of individuals aged ≥75 years with eGFR < 20 ml/min/1.73 m2 followed by a nephrologist, who collected their active prescriptions at the study inclusion visit. Medication profiles were first analyzed according to route of administration, therapeutic classification. Second, patients were classified according to their risk of potential medication-related problems, based on whether the prescription was a RIM or a PIM. RIMs and PIMs have been defined according to renal appropriateness guidelines and to Beer's criteria in the elderly. RIMs were subclassified by 4 types of category: (a) contraindication; (b) dose modification is recommended based on creatinine clearance (CrCl); (c) dose modification based on CrCl is not recommended but a maximum daily dose is mentioned, (d) no specific recommendations based on CrCl: "use with caution", "avoid in severe impairment", "careful monitoring of dose is required" "reduce the dose". RESULTS We collected 5196 individual medication prescriptions for 556 patients, for a median of 9 daily medications [7-11]. Antihypertensive agents, antithrombotics, and antianemics were the classes most frequently prescribed. Moreover, 77.0% of patients had at least 1 medication classified as a RIM. They accounted 31.3% of the drugs prescribed and 9.25% was contraindicated drugs. At least 1 PIM was taken by 57.6 and 45.5% of patients had at least one medication classified as RIM and PIM. The prescriptions most frequently requiring reassessment due to potential adverse effects were for proton pump inhibitors and allopurinol. The PIMs for which deprescription is especially important in this population are rilmenidine, long-term benzodiazepines, and anticholinergic drugs such as hydroxyzine. CONCLUSION We showed potential drug-related problems in elderly patients with advanced CKD. Healthcare providers must reassess each medication prescribed for this population, particularly the specific medications identified here. TRIAL REGISTRATION NCT02910908.
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Affiliation(s)
- Clarisse Roux-Marson
- Department of Pharmacy, Nîmes University Hospital, Nîmes, France. .,Laboratoire Epidemiologie, Santé Publique, Biostatistiques, Université Montpellier, EA2415, Nimes, France.
| | | | - Coraline Fafin
- Department of Nephrology, Dialysis and Apheresis, Nîmes University Hospital, Nîmes, France
| | | | - Cecile Vigneau
- CHU Rennes, Department of nephrology, 3 rue H le Guilloux, 35000, Rennes, France.,INSERM U1085-IRSET, Rennes, France
| | - Cecile Couchoud
- REIN registry, Agence de la biomédecine, 1 avenue du stade de France, 93212 Saint Denis La Plaine, Saint-Denis, France.,Laboratoire Biostatistique Santé Université Claude Bernard Lyon I, UMR CNRS 5558, Lyon, France
| | - Olivier Moranne
- Laboratoire Epidemiologie, Santé Publique, Biostatistiques, Université Montpellier, EA2415, Nimes, France. .,Department of Nephrology, Dialysis and Apheresis, Nîmes University Hospital, Nîmes, France.
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Identifying characteristics of drug-related problems in critically ill patients with decompensated liver cirrhosis. Eur J Gastroenterol Hepatol 2019; 31:1569-1576. [PMID: 31464786 DOI: 10.1097/meg.0000000000001492] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVES Characteristics of drug-related problems and related patient harm has not been evaluated in critically ill patients with decompensated cirrhosis. Our objectives were to identify characteristics and incidence rate of drug-related problems and related preventable harm in critically ill patients with decompensated liver cirrhosis. PATIENTS AND METHODS A prospective observational study was conducted from February 2018 to January 2019 in 10-bed medical intensive care unit of a tertiary care hospital. Medication charts of 78 patients diagnosed with decompensated cirrhosis were reviewed by the clinical pharmacist. Pharmaceutical care-related standard tools were applied for classification of drug-related problems and their severity of outcomes. RESULTS A total of 394 drug-related problems with an incidence rate of 298.48 per 1000 patient medical intensive care unit-day were identified. Most common drug-related problems were drug-drug interaction (48.7%) followed by guideline nonconformity (15.5%), inappropriate drug form (11.9%), and contraindication (9.6%). Approximately 27% of drug-related problems induced preventable harm, which included temporary harm (19.8%), permanent harm (5.8%), and death (0.8%). The incidence rate of preventable harm was found to be 78.78 per 1000 patient medical intensive care unit-day. Nonsteroidal anti-inflammatory drugs were the most common medications involved in drug-drug interaction, guideline nonconformity, and contraindication which led to gastrointestinal bleeding (24%) and worsening of renal function (11.5%). CONCLUSION Drug-related problems occurred commonly in critically ill patients with decompensated liver cirrhosis and induced preventable harm which jeopardized the safety of these vulnerable patients. Clinical pharmacist's intervention is essential for identification of drug-related problems and related preventable harm among these patients.
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Drug-Related Problems and Associated Factors among Patients Admitted with Chronic Kidney Disease at Jimma University Medical Center, Jimma Zone, Jimma, Southwest Ethiopia: A Hospital-Based Prospective Observational Study. Int J Nephrol 2019; 2019:1504371. [PMID: 31772774 PMCID: PMC6854244 DOI: 10.1155/2019/1504371] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 08/05/2019] [Accepted: 08/24/2019] [Indexed: 02/07/2023] Open
Abstract
Background There is an alarming rise of chronic kidney disease prevalence globally associated with significant morbidity and mortality necessitating special attention as one of the major growing public health problems. Medication-related problems are common in hospitalized patients including chronic kidney disease and may lead to increase hospital stay and health care cost and augment the risk of morbidity and mortality. Objective To determine prevalence of medication-related problems and associated factors among chronic kidney disease patients admitted to Jimma University Medical Center from April to September 2018. Methods A hospital-based prospective observational study was conducted among 103 chronic kidney disease patients admitted to Jimma University Medical Center from April to September 2018. Data regarding patient characteristics, medications, diagnosis, length of hospitalization, and laboratory results were collected through review of patients' medical charts. Data were analyzed by using Statistical Package for the Social Sciences (SPSS) version 21.0. Univariate and multivariate logistic regression was utilized to assess the associations between dependent and independent variables. Statistical significance was considered at p value <0.05. Results Out of 103 chronic kidney disease patients, 81 (78.6%) of patients had MDRs, on average 1.94 ± 0.873 per patient. The rate of overall MRPs was 30.95 per 100 medication orders. The most common MRPs among CKD patients were need additional drug therapy (62 (31%)), nonadherence (40 (20%)), and dose too low (36 (18%)). The most common cause of need additional drug therapy (52 (26%)) was untreated medical conditions; nonadherence (19 (9.5%)) was mostly due to that the patient/caregiver forgets to take/give the medication, and dose too low (29 (14.5%)) was mostly due to that the dose is too low to produce the desired response. Polypharmacy (AOR = 4.695, 95% CI: 1.370-16.091), number of comorbidities (AOR = 3.616, 95% CI: 1.015-1.8741), and stage of CKD (AOR = 3.941, 95% CI: 1.221-12.715) were independent predictors for MRPs. Conclusions We have demonstrated that medication-related problems are high among chronic kidney disease patients. Marital statuses, stage of CKD, polypharmacy, and comorbidity were independent predictors for MRPs. Interdisciplinary health professionals should work to decrease the high prevalence of MRPs among chronic kidney disease patients.
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Tesfaye WH, Peterson GM, Castelino RL, McKercher C, Jose M, Zaidi STR, Wimmer BC. Medication-Related Factors and Hospital Readmission in Older Adults with Chronic Kidney Disease. J Clin Med 2019; 8:jcm8030395. [PMID: 30901955 PMCID: PMC6462973 DOI: 10.3390/jcm8030395] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 03/15/2019] [Accepted: 03/19/2019] [Indexed: 12/20/2022] Open
Abstract
This study aimed to examine the association between medication-related factors and risk of hospital readmission in older patients with chronic kidney disease (CKD). A retrospective analysis was conducted targeting older CKD (n = 204) patients admitted to an Australian hospital. Medication appropriateness (Medication Appropriateness Index; MAI), medication regimen complexity (number of medications and Medication Regimen Complexity Index; MRCI) and use of selected medication classes were exposure variables. Outcomes were occurrence of readmission within 30 and 90 days, and time to readmission within 90 days. Logistic and Cox hazards regression were used to identify factors associated with readmission. Overall, 50 patients (24%) were readmitted within 30 days, while 81 (40%) were readmitted within 90 days. Mean time to readmission within 90 days was 66 (SD 34) days. Medication appropriateness and regimen complexity were not independently associated with 30- or 90-day hospital readmissions in older adults with CKD, whereas use of renin‒angiotensin blockers was associated with reduced occurrence of 30-day (adjusted OR 0.39; 95% CI 0.19⁻0.79) and 90-day readmissions (adjusted OR 0.45; 95% CI 0.24⁻0.84) and longer time to readmission within 90 days (adjusted HR 0.52; 95% CI 0.33⁻0.83). This finding highlights the importance of considering the potential benefits of individual medications during medication review in older CKD patients.
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Affiliation(s)
- Wubshet H Tesfaye
- Pharmacy, School of Medicine, College of Health and Medicine, University of Tasmania, Sandy Bay, TAS 7005, Australia.
| | - Gregory M Peterson
- Pharmacy, School of Medicine, College of Health and Medicine, University of Tasmania, Sandy Bay, TAS 7005, Australia.
| | - Ronald L Castelino
- Sydney Nursing School, The University of Sydney, Sydney, NSW 2006, Australia.
| | - Charlotte McKercher
- Menzies Institute for Medical Research, University of Tasmania, Hobart 7005, Australia.
| | - Matthew Jose
- Menzies Institute for Medical Research, University of Tasmania, Hobart 7005, Australia.
- Royal Hobart Hospital, University of Tasmania, GPO Box-1061, Hobart 7000, Australia.
| | | | - Barbara C Wimmer
- Pharmacy, School of Medicine, College of Health and Medicine, University of Tasmania, Sandy Bay, TAS 7005, Australia.
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Boutin K, Nevers W, Gorman SK, Slavik RS, Martinusen DJ, Lo C. Development of intervention-related quality indicators for renal clinical pharmacists using a modified Delphi approach. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2018; 27:436-442. [PMID: 30209834 DOI: 10.1111/ijpp.12484] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 07/31/2018] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To develop a list of renal Quality Indicator Drug therapy problems (QI-DTPs) that serve to advance renal pharmacy practice to improve patient care. METHODS Eighteen (18) renal, clinical pharmacists participated in an internet-based three-round modified Delphi survey. Each of the three rounds took approximately 2 weeks to complete. Panellists rated 30-candidate renal QI-DTPs using seven selection criteria and one overall consensus criterion on a nine-point Likert scale. Consensus was reached if 75% or more of panellists assigned a score of 7-9 on the consensus criterion during the third Delphi round. KEY FINDINGS All panellists completed three rounds of Delphi survey. Seventeen-candidate renal QI-DTPs met the consensus definition. CONCLUSIONS A Delphi panel of renal clinical pharmacists successfully identified 17 consensus renal QI-DTPs. Assessment and implementation of these QI-DTPs will serve to advance renal pharmacy practice and improve patient care.
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Affiliation(s)
- Katherine Boutin
- Pharmacy Services, Kelowna General Hospital, Kelowna, BC, Canada
| | - William Nevers
- Pharmacy Services, Kelowna General Hospital, Kelowna, BC, Canada
| | - Sean K Gorman
- Interior Health Pharmacy Services, Kelowna, BC, Canada
| | | | - Daniel J Martinusen
- Island Health Pharmacy Services, British Columbia Provincial Renal Agency, Faculty of Pharmaceutical Sciences, University of British Columbia, Victoria, BC, Canada
| | - Clifford Lo
- Lower Mainland Pharmacy Services, British Columbia Provincial Renal Agency, Vancouver, BC, Canada
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Fasipe OJ, Olayemi SO, Akinyede AA, Osho PO, Ibiyemi-Fasipe OB, Osho ES. How do we prevent the burden of extremely harmful and clinically nonbeneficial drug–drug interactions among chronic kidney disease patients? TOXICOLOGY RESEARCH AND APPLICATION 2018. [DOI: 10.1177/2397847318794861] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The chronic intake of different medications by chronic kidney disease (CKD) patients predisposes them to extremely harmful and clinically nonbeneficial drug–drug interactions (DDIs) which can ultimately lead to increase in morbidity, mortality, healthcare cost, and frequency and length of hospitalization. This produces a negative deteriorating and counter-efficient outcome on the health, quality of life and treatment response of these patients. This was an 18-month prospective descriptive study that reviewed the medical case records of consented adult CKD patients attending the Nephrology medical outpatient clinic of a Nigerian Tertiary Healthcare Centre from January 2015 to June 2016. The Medscape drug reference database was used to evaluate patients’ medications for extremely harmful, clinically nonbeneficial DDIs. This study involved 123 consented adult CKD patients comprising of 82 (66.67%) males and 41 (33.33%) females with a mean age of 53.81 ± 16.03 years. In this study, the prevalence of extremely harmful, clinically nonbeneficial DDIs (type D or type X interaction categories only) was 24.4%, while the overall prevalence for all the observed DDIs was 95.9%. The most frequent extremely harmful, clinically nonbeneficial DDIs in this study was between α-methyldopa and metoclopramide: 16 (0.9%) interactions in eight (6.5%) patients. Furthermore, α-methyldopa decreases the antiemetic effects of metoclopramide by pharmacodynamics antagonism at the chemoreceptor trigger zone site D2-receptors (type X; pharmacodynamics). In addition, metoclopramide decreases the level of α-methyldopa by inhibition of gastrointestinal tract (GIT) absorption, as this applies to only oral formulations of both agents (type D; pharmacokinetic). The occurrence and burden of extremely harmful, clinically nonbeneficial DDIs is significantly high among these CKD patients. There is also a critical need to minimize the number of prescribed medications for these patients in order to optimize their care.
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Affiliation(s)
- Olumuyiwa John Fasipe
- Department of Pharmacology and Therapeutics, Faculty of Basic Clinical Sciences, University of Medical Sciences, Ondo City, Ondo State, Nigeria
| | - Sunday Olufemi Olayemi
- Department of Pharmacology, Therapeutics and Toxicology, Faculty of Basic Medical Sciences, University of Lagos, Yaba, Lagos State, Nigeria
| | - Akinwumi Akinyinka Akinyede
- Department of Pharmacology, Therapeutics and Toxicology, Faculty of Basic Medical Sciences, University of Lagos, Yaba, Lagos State, Nigeria
| | - Patrick Olanrewaju Osho
- Department of Hematology, Faculty of Basic Clinical Sciences, University of Medical Sciences, Ondo City, Ondo State, Nigeria
| | - Oluwatosin Beatrice Ibiyemi-Fasipe
- Department of Pharmacology and Therapeutics, Faculty of Basic Clinical Sciences, University of Medical Sciences, Ondo City, Ondo State, Nigeria
| | - Evelyn Salewa Osho
- Department of Radiology, Trauma Surgical Center, University of Medical Sciences, Ondo City, Ondo State, Nigeria
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Tesfaye WH, Peterson GM, Castelino RL, McKercher C, Jose MD, Wimmer BC, Zaidi STR. Medication Regimen Complexity and Hospital Readmission in Older Adults With Chronic Kidney Disease. Ann Pharmacother 2018; 53:28-34. [PMID: 30070583 DOI: 10.1177/1060028018793419] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Chronic kidney disease (CKD) is characterized by high rates of hospital admissions and readmissions. However, there is a scarcity of research into medication-related factors predicting such outcomes in this patient group. OBJECTIVE To evaluate the effect of medication regimen complexity at hospital discharge on subsequent readmissions and their timing in older adults with CKD. METHODS This was a 12-month retrospective cohort study of 204 older (⩾65 years) CKD patients in an Australian tertiary care hospital. Medication regimen complexity was quantified using the 65-item medication regimen complexity index (MRCI). The outcomes were the occurrence of readmission in 30 days and time to readmission within 12 months. Logistic regression was used to identify factors predicting 30-day readmission, and a competing risks proportional subdistribution hazard model, accounting for deaths, was used for factors predicting time to readmission. RESULTS Overall, 50 (24%) patients, predominantly men (72%), were readmitted within 30 days of follow-up. MRCI was not significantly associated with 30-day readmission (odds ratio [OR] = 1.27; 95% CI = 0.94-1.73). The median (interquartile range) time to readmission within 12 months was 145 (31-365) days. On a multivariate analysis, a 10-unit increase in MRCI was associated with a shorter time to readmission within 12 months (subdistribution HR = 1.18; 95% CI = 1.01-1.36). Conclusion and Relevance: Medication regimen complexity was not significantly associated with 30-day readmission; however, it was associated with a significantly shorter time to 12-month readmission in older CKD patients. This finding highlights the importance of medication regimen complexity as a potential target for medical interventions to reduce readmission risks.
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Affiliation(s)
| | | | | | | | - Matthew D Jose
- 3 Menzies Institute for Medical Research, Hobart, Tasmania, Australia
- 4 Royal Hobart Hospital, Tasmania, Australia
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Alshamrani M, Almalki A, Qureshi M, Yusuf O, Ismail S. Polypharmacy and Medication-Related Problems in Hemodialysis Patients: A Call for Deprescribing. PHARMACY 2018; 6:E76. [PMID: 30046021 PMCID: PMC6163628 DOI: 10.3390/pharmacy6030076] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 07/14/2018] [Accepted: 07/18/2018] [Indexed: 12/02/2022] Open
Abstract
Polypharmacy is a common problem among hemodialysis patients. It is associated with increased hospital admissions, morbidity, mortality, Medication-Related Problems (MRPs), and expenditures. There is a paucity of data on the prevalence of polypharmacy in our setting. This study aims to determine the prevalence of polypharmacy and MRPs and to assess its predictors. We conducted a cross-sectional study in the outpatient hemodialysis unit. A pharmacy resident assessed electronic prescribing records to identify MRPs and discussed therapeutic interventions to enhance effective therapeutic regimens over a three months period. Eighty-three patients were included. The median age was 63 (Interquartile range; IQR = 22), 50% were males, and the mean number of co-morbidities was 3.14 ± 1.64. The prevalence of polypharmacy was 97.6% with a 95% CI (91.6%⁻99.7%). Medication use without indication, was the highest identified MRPs at 36% (102/280), followed by subtherapeutic dosing at 23% (65/280), and overdosing at 15% (41/280). The number of comorbidities, the presence of ischemic heart disease, and respiratory diseases were the main predictors of the increased number of medications. Polypharmacy is highly prevalent among the Saudi hemodialysis population. A review of the medications prescribed by the pharmacist facilitated the identification of MRPs and provided opportunities for deprescribing to optimize medication use and to reduce polypharmacy in hemodialysis patients.
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Affiliation(s)
- Majed Alshamrani
- King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Pharmaceutical Care Department, King Khalid Hospital, Ministry of National Guard Health Affairs, Jeddah 21423, Saudi Arabia.
| | - Abdullah Almalki
- King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Department of Medicine, Nephrology Section, King Khalid Hospital, Ministry of National Guard Health Affairs, Jeddah 21423, Saudi Arabia.
| | - Mohamed Qureshi
- King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Department of Medicine, Nephrology Section, King Khalid Hospital, Ministry of National Guard Health Affairs, Jeddah 21423, Saudi Arabia.
| | - Oyindamola Yusuf
- Department of Epidemiology and Medical Statistics, College of Medicine, University of Ibadan, Ibadan, Nigeria.
| | - Sherine Ismail
- King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Pharmaceutical Care Department, King Khalid Hospital, Ministry of National Guard Health Affairs, Jeddah 21423, Saudi Arabia.
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Njeri LW, Ogallo WO, Nyamu DG, Opanga SA, Birichi AR. Medication-related problems among adult chronic kidney disease patients in a sub-Saharan tertiary hospital. Int J Clin Pharm 2018; 40:1217-1224. [DOI: 10.1007/s11096-018-0651-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 05/05/2018] [Indexed: 11/24/2022]
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Pai AB. Why Nomenclature for Pharmacist-Led Interventions Matters: Conquering the State of Confusion. Clin J Am Soc Nephrol 2018; 13:198-200. [PMID: 29295828 PMCID: PMC5967440 DOI: 10.2215/cjn.13601217] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Amy Barton Pai
- Department of Clinical Pharmacy, College of Pharmacy, University of Michigan, Ann Arbor, Michigan
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Fu CM, Chang CH, Lee CC, Fan PC, Chen SW, Lee CT, Wu CH, Li LC, Chen TH. Impact of dialysis dependence on prognosis in patients with myocardial infarction: An 11-year population-based study. Medicine (Baltimore) 2018; 97:e9833. [PMID: 29419688 PMCID: PMC5944684 DOI: 10.1097/md.0000000000009833] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
In this study we aimed to directly compare the short and long-term prognosis of nondialysis patients with chronic kidney disease (CKD), dialysis patients, and patients with preserved renal function after acute myocardial infarction (AMI).AMI in patients with CKD is a catastrophic event associated with high medical expenditures and dismal survival. However, there is little research comparing post-AMI outcomes between patients with CKD who were and were not receiving dialysis.The retrospective cohort study included patients with AMI (n = 158,125) in the Taiwan's National Health Insurance Research Database who were treated March 1998 and December 2009. Patients were classified into a nondialysis CKD group (n = 6300), dialysis group (n = 5140), and a control group (n = 146,685). The clinical characteristics, in-hospital events, and long-term outcomes of these 3 groups were compared separately using a multivariable Cox proportional hazard model.The risks of in-hospital death and 2-year all-cause mortality were the highest in the dialysis group, followed by the nondialysis CKD group, and were the lowest in the control group. The 1-year risk of myocardial infarction did not differ among the 3 study groups, but the 2-year risk of myocardial infarction was higher in the dialysis group than in the control group (hazard ratio, 1.13; 95% confidence interval, 1.03-1.24; P = .010).Patients with CKD experienced adverse short- and long-term outcomes after acute myocardial infarction. Patients with CKD, especially those who are dialysis dependent, may require more intensive management to improve their post-AMI clinical outcomes.
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Affiliation(s)
- Chung-Ming Fu
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung
| | - Chih-Hsiang Chang
- Department of Nephrology, Kidney Research Center, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University
| | - Cheng-Chia Lee
- Department of Nephrology, Kidney Research Center, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University
| | - Pei-Chun Fan
- Department of Nephrology, Kidney Research Center, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University
| | - Shao-Wei Chen
- Department of Cardiothoracic and Vascular Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan
| | - Chien-Te Lee
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung
| | - Chien-Hsing Wu
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung
| | - Lung-Chih Li
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung
| | - Tien-Hsing Chen
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Keelung, Taiwan
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Fasipe OJ, Akhideno PE, Nwaiwu O, Adelosoye AA. Assessment of prescribed medications and pattern of distribution for potential drug-drug interactions among chronic kidney disease patients attending the Nephrology Clinic of Lagos University Teaching Hospital in Sub-Saharan West Africa. Clin Pharmacol 2017; 9:125-132. [PMID: 29123429 PMCID: PMC5661841 DOI: 10.2147/cpaa.s147835] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION Life expectancy has increased significantly among chronic kidney disease (CKD) patients due to the extensive use of polypharmacy practice for medication prescriptions. This predisposes them to potential drug-drug interactions (DDIs), which can lead to an increase in morbidity, mortality, length of hospital stay, and health care cost. METHODS This was a 30-month retrospective study that reviewed the medical case records of consenting adult CKD patients from January 2014 to June 2016. The Medscape drug reference database was used to evaluate patients' medications for potential DDIs. RESULTS This study involved 123 adult CKD patients (63 [51.22%] males and 60 [48.78%] females) with a mean age of 53.81±16.03 years. The most common comorbid conditions were hypertension (112 [91.10%]) and diabetes mellitus (45 [36.60%]). Regarding the form of nephrological interventions being offered, the majority of the respondents - 66 (53.66%) were on maintenance dialysis, followed by 53 (43.09%) respondents on conservative care, while 4 (3.25%) respondents were on renal transplantation. A total of 1264 prescriptions were made, and the mean number of prescribed medications per patient was 10.28±3.85. The most frequently prescribed medications were furosemide (88 [71.6%]), heparin (67 [54.47%]), lisinopril (65 [52.9%]), oral calcium carbonate (CaCO3) (63 [51.2%]), α-calcidol (62 [50.4%]), and erythropoietin (61 [49.6%]). A total number of 1851 potential DDIs were observed among 118 patients. The prevalence of potential DDIs in this study was 78.0%, while the mean DDI per prescription was 1.50. Among the potential DDIs observed, the severity was mild in 639 (34.5%) patients, moderate in 1160 (62.7%) patients, and major in 51 (2.8%) patients and only 1 (0.1%) patient was of contraindicated drug combination. The most frequent DDIs' pattern observed was between oral CaCO3 and oral ferrous sulfate. There was a statistically significant association between the number of prescribed medications and the estimated glomerular filtration rate (eGFR; pre-ESRD and ESRD staging) with a P-value of 0.00000119. This implies that the number of prescribed medications increases as the eGFR declines in advance CKD stage patients. CONCLUSION Most of these interactions have moderate severity and delayed onset, hence the need to follow-up these patients after prescription in order to reduce associated morbidity, mortality, length of hospital stay, and health care cost. Physicians and clinical pharmacists should utilise available interaction software to avoid harmful DDIs in these patients.
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Affiliation(s)
- Olumuyiwa John Fasipe
- Department of Pharmacology & Therapeutics, University of Medical Sciences, Ondo City, Ondo State
| | | | - Obiyo Nwaiwu
- Department of Pharmacology & Therapeutics, University of Lagos, Yaba, Lagos State
| | - Alex Adedotun Adelosoye
- Department of Family Medicine, University of Medical Sciences, Ondo City, Ondo State, Nigeria
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Parker WM, Ferreira K, Vernon L, Cardone KE. The delicate balance of keeping it all together: Using social capital to manage multiple medications for patients on dialysis. Res Social Adm Pharm 2017; 13:738-745. [DOI: 10.1016/j.sapharm.2016.07.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 06/30/2016] [Accepted: 07/07/2016] [Indexed: 10/21/2022]
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Galura G, Pai AB. Health Literacy and Medication Management in Chronic Kidney Disease. Health Lit Res Pract 2017; 1:e109-e115. [PMID: 31294256 PMCID: PMC6607792 DOI: 10.3928/24748307-20170607-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 06/05/2017] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Amy Barton Pai
- Address correspondence to Amy Barton Pai, PharmD, BCPS, FASN, FCCP, FNKF, Department of Clinical Pharmacy, University of Michigan College of Pharmacy, 428 Church Street, Ann Arbor, MI 48109;
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Ong SW, Jassal SV, Miller JA, Porter EC, Cafazzo JA, Seto E, Thorpe KE, Logan AG. Integrating a Smartphone-Based Self-Management System into Usual Care of Advanced CKD. Clin J Am Soc Nephrol 2016; 11:1054-1062. [PMID: 27173169 PMCID: PMC4891756 DOI: 10.2215/cjn.10681015] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Accepted: 02/12/2016] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Patient self-management has been shown to improve health outcomes. We developed a smartphone-based system to boost self-care by patients with CKD and integrated its use into usual CKD care. We determined its acceptability and examined changes in several clinical parameters. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS We recruited patients with stage 4 or 5 CKD attending outpatient renal clinics who responded to a general information newsletter about this 6-month proof-of-principle study. The smartphone application targeted four behavioral elements: monitoring BP, medication management, symptom assessment, and tracking laboratory results. Prebuilt customizable algorithms provided real-time personalized patient feedback and alerts to providers when predefined treatment thresholds were crossed or critical changes occurred. Those who died or started RRT within the first 2 months were replaced. Only participants followed for 6 months after recruitment were included in assessing changes in clinical measures. RESULTS In total, 47 patients (26 men; mean age =59 years old; 33% were ≥65 years old) were enrolled; 60% had never used a smartphone. User adherence was high (>80% performed ≥80% of recommended assessments) and sustained. The mean reductions in home BP readings between baseline and exit were statistically significant (systolic BP, -3.4 mmHg; 95% confidence interval, -5.0 to -1.8 and diastolic BP, -2.1 mmHg; 95% confidence interval, -2.9 to -1.2); 27% with normal clinic BP readings had newly identified masked hypertension. One hundred twenty-seven medication discrepancies were identified; 59% were medication errors that required an intervention to prevent harm. In exit interviews, patients indicated feeling more confident and in control of their condition; clinicians perceived patients to be better informed and more engaged. CONCLUSIONS Integrating a smartphone-based self-management system into usual care of patients with advanced CKD proved feasible and acceptable, and it appeared to be clinically useful. The results provide a strong rationale for a randomized, controlled trial.
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Affiliation(s)
| | - Sarbjit V. Jassal
- Medicine
- Nephrology
- Institute of Health Policy, Management and Evaluation
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Judith A. Miller
- Medicine
- Nephrology
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | - Joseph A. Cafazzo
- Techna Institute, University Health Network, Toronto, Ontario, Canada
- Lunenfeld-Tanenbaum Research Institute and Department of Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation
- Institute of Biomaterials and Biomedical Engineering
| | - Emily Seto
- Centre for Global eHealth Innovation, and
- Techna Institute, University Health Network, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation
| | - Kevin E. Thorpe
- Dalla Lana School of Public Health, University of Toronto, and
- Applied Health Research Centre, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Alexander G. Logan
- Medicine
- Nephrology
- Lunenfeld-Tanenbaum Research Institute and Department of Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Hsu KL, Fink JC, Ginsberg JS, Yoffe M, Zhan M, Fink W, Woods CM, Diamantidis CJ. Self-reported Medication Adherence and Adverse Patient Safety Events in CKD. Am J Kidney Dis 2015; 66:621-9. [PMID: 25979348 PMCID: PMC4586079 DOI: 10.1053/j.ajkd.2015.03.026] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Accepted: 03/06/2015] [Indexed: 11/11/2022]
Abstract
BACKGROUND Promoting medication adherence is a recognized challenge for prescribers. In this study, we examine whether lower medication adherence is associated with adverse safety events in individuals with decreased estimated glomerular filtration rates (eGFRs). STUDY DESIGN Cross-sectional baseline analysis of prospective cohort. SETTING & PARTICIPANTS Baseline analysis of the Safe Kidney Care (SKC) Cohort Study, a prospective study of individuals with eGFRs<60 mL/min/1.73 m(2) intended to assess the incidence of disease-specific safety events. Kidney transplant recipients were excluded. PREDICTOR Self-reported medication adherence based on responses to 3 questions ascertaining degree of medication regimen adherence. OUTCOMES Adverse safety events were self-reported at baseline (class I events), such as hypoglycemia or fall thought to be related to a medication, or detected incidentally during the baseline visit (class II events), for example, hypotension or hyperkalemia. Potential drug-related problems (DRPs) were determined by analyzing participants' medications with respect to dosing guidelines based on their screening eGFRs at the time of medication reporting. MEASUREMENTS Relationship between medication adherence and disease-specific patient safety events. RESULTS Of 293 SKC participants, 154 (53%) were classified as having lower medication adherence. After multivariable adjustment, lower medication adherence was significantly associated with a class I or II safety event (prevalence ratio [PR], 1.21; 95% CI, 1.04-1.41) and potential DRPs (PR, 1.29; 95% CI, 1.02-1.63). Lower medication adherence was also significantly associated with multiple (≥2) class I events (PR, 1.71; 95% CI, 1.18-2.49), multiple class I or II events (PR, 1.35; 95% CI, 1.04-1.76), and multiple potential DRPs (PR, 2.11; 95% CI, 1.08-2.69) compared with those with higher medication adherence. LIMITATIONS Use of self-reported medication adherence rather than pharmacy records. Clinical relevance of detected safety events is unclear. CONCLUSIONS Lower medication adherence is associated with adverse safety events in individuals with eGFRs<60 mL/min/1.73 m(2).
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Affiliation(s)
- Kailin L Hsu
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Jeffrey C Fink
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD; Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD; Department of Medicine, Veterans Affairs Maryland Health Care System, Baltimore, MD
| | - Jennifer S Ginsberg
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Marni Yoffe
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Min Zhan
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD
| | - Wanda Fink
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD
| | | | - Clarissa J Diamantidis
- Department of Medicine, Duke University School of Medicine, Durham, NC; Department of Medicine, Durham Veterans Affairs Medical Center, Durham, NC.
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Parker WM, Jang SM, Muzzy JD, Cardone KE. Multidisciplinary views toward pharmacist-delivered medication therapy management services in dialysis facilities. J Am Pharm Assoc (2003) 2015; 55:390-7. [DOI: 10.1331/japha.2015.14168] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Colantonio LD, Baber U, Banach M, Tanner RM, Warnock DG, Gutiérrez OM, Safford MM, Wanner C, Howard G, Muntner P. Contrasting Cholesterol Management Guidelines for Adults with CKD. J Am Soc Nephrol 2015; 26:1173-80. [PMID: 25395432 PMCID: PMC4413767 DOI: 10.1681/asn.2014040400] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Accepted: 07/24/2014] [Indexed: 11/03/2022] Open
Abstract
The Kidney Disease Improving Global Outcomes Lipid Work Group recommends statins for adults ≥50 years old with CKD. The American College of Cardiology/American Heart Association endorses statins for adults with atherosclerotic cardiovascular disease, adults with LDL cholesterol≥190 mg/dl, and adults 40-79 years old with LDL cholesterol=70-189 mg/dl and diabetes or a 10-year predicted risk for atherosclerotic cardiovascular disease ≥7.5% estimated using the Pooled Cohort risk equations. Using data from the Reasons for Geographic and Racial Differences in Stroke Study, we calculated the agreement for statin treatment between these two guidelines for adults 50-79 years old with CKD (eGFR<60 ml/min per 1.73 m(2) or albuminuria≥30 mg/g) not on dialysis. We assessed the validity of the Pooled Cohort risk equations in individuals with CKD. Study participants were enrolled between 2003 and 2007, and we report incident cardiovascular disease events (stroke and coronary heart disease) through December of 2010. Among 4726 participants with CKD, 2366 (50%) were taking statins, and 1984 (42%) were recommended statins by the American College of Cardiology/American Heart Association guideline but not taking them. Overall, 376 (8%) participants did not meet the American College of Cardiology/American Heart Association criteria for initiating statin treatment. Cardiovascular disease incidence was low (3.0/1000 person-years; 95% confidence interval, 0.1 to 5.9) among these participants. The Pooled Cohort risk equations were well calibrated (Hosmer-Lemeshow chi-squared=2.7, P=0.45) with moderately good discrimination (C index, 0.71; 95% confidence interval, 0.65 to 0.77). In conclusion, these guidelines show high concordance for statin treatment for adults with CKD.
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Affiliation(s)
| | - Usman Baber
- Cardiovascular Institute, Mount Sinai School of Medicine, New York, New York
| | - Maciej Banach
- Department of Hypertension, Medical University of Lodz, Lodz, Poland; and
| | | | | | | | | | - Christoph Wanner
- Department of Medicine, Division of Nephrology, University Hospital Würzburg, Würzburg, Germany
| | - George Howard
- Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama
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Ibrahim N, Wong ICK, Tomlin S, Sinha MD, Rees L, Jani Y. Epidemiology of medication-related problems in children with kidney disease. Pediatr Nephrol 2015; 30:623-33. [PMID: 25352402 PMCID: PMC4333303 DOI: 10.1007/s00467-014-2982-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2014] [Revised: 09/04/2014] [Accepted: 09/05/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND Medication-related problems (MRPs) are the undesirable effects of pharmacotherapy that can potentially lead to harm. The epidemiology of MRPs in paediatric renal patients is unknown. We aimed to characterise MRPs in this population at two tertiary care hospitals in the UK. METHODS Prescription charts for children (≤18 years) were reviewed to identify MRPs, and characterised using a specific proforma with a standard operational definition. MRP predictors were evaluated by logistic regression and severity was assessed using a validated scale. RESULTS Two hundred and sixty-seven MRPs were identified from 266 prescription chart reviews. The incidence was 51.2 % (203 MRPs, 166 charts; 95 % CI 43.2-60.6 %) of hospitalised patients and 32 % (64 MRPs, 100 charts; 95 % CI 22.9-41.1 %) in outpatients. The number of prescribed medications was the only independent predictor during inpatient treatment (OR 1.06, 95 % CI 1.02-1.10, p = 0.002) with no significant predictors identified at outpatient clinics. The severity level of the MRPs was minor: 53.9 %, (144 out of 267); or moderate: 46.1 %, (123 out of 267). Sub-optimal drug effect was the predominant MRP (inpatient: 68 %; outpatient: 39 %). Prescribing error and patients' medicine-taking behaviour were the main contributory factors. The majority of the MRPs in the inpatient setting were resolved. CONCLUSION Many factors are associated with MRPs in children; the associations are cumulative and interdependent. Investment in preventive strategies and extending the support from the acute health care setting into the community are invaluable for optimising pharmacotherapy.
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Affiliation(s)
- Norkasihan Ibrahim
- Centre for Paediatric Pharmacy Research, School of Pharmacy, University College London, London, UK
- Pharmacy Department, Paediatric Institute, General Hospital Kuala Lumpur, 50586 Jalan Pahang, Kuala Lumpur, Malaysia
| | - Ian Chi Kei Wong
- Centre for Paediatric Pharmacy Research, School of Pharmacy, University College London, London, UK
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, China
- Li Ka Shing Faculty of Medicine, University of Hong Kong, 2/F, 21 Sassoon Road, Laboratory Block, Faculty of Medicine Building, Hong Kong, China
| | - Stephen Tomlin
- Pharmacy Department, Evelina London Children’s Hospital, Guy’s and St. Thomas’ Hospital NHS Foundation Trust, King’s Health Partners, London, UK
| | - Manish D. Sinha
- Department of Paediatric Nephrology, Evelina London Children’s Hospital, Guy’s and St. Thomas’ Hospital NHS Foundation Trust, King’s Health Partners, London, UK
| | - Lesley Rees
- Department of Nephrology, Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Yogini Jani
- Centre for Paediatric Pharmacy Research, School of Pharmacy, University College London, London, UK
- Pharmacy Department, University College London Hospital NHS Foundation Trust, London, UK
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Wu J, Ginsberg JS, Zhan M, Diamantidis CJ, Chen J, Woods C, Fink JC. Chronic pain and analgesic use in CKD: implications for patient safety. Clin J Am Soc Nephrol 2015; 10:435-42. [PMID: 25710806 DOI: 10.2215/cjn.06520714] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND AND OBJECTIVES Chronic pain in predialysis CKD is not fully understood. This study examined chronic pain in CKD and its relationship with analgesic usage. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Data include baseline visits from 308 patients with CKD enrolled between 2011 and 2013 in the Safe Kidney Care cohort study in Baltimore, Maryland. The Wong-Baker FACES Pain Rating Scale measured chronic pain severity. Analgesic prescriptions and over-the-counter purchases were recorded up to 30 days before visits, and were classified as a drug-related problem (DRP) based on an analgesic's nephrotoxicity and dose appropriateness at participants' eGFR. Participants were sorted by pain frequency and severity and categorized into ordinal groups. Analgesic use and the rate of analgesics with a DRP were reported across pain groups. Multivariate regression determined the factors associated with chronic pain and assessed the relationship between chronic pain and analgesic usage. RESULTS There were 187 (60.7%) participants who reported chronic pain. Factors associated with pain severity included arthritis, taking ≥12 medications, and lower physical function. Use of nonsteroidal anti-inflammatory drugs was reported by seven participants (5.8%) with no chronic pain. Mild and severe chronic pain were associated with analgesics with a DRP, with odds ratios of 3.04 (95% confidence interval [95% CI], 1.12 to 8.29) and 5.46 (95% CI, 1.85 to 16.10), respectively. The adjusted rate of analgesics with a DRP per participant increased from the group with none to severe chronic pain, with rates of 0.07 (95% CI, 0.04 to 0.13), 0.12 (95% CI, 0.07 to 0.20) and 0.16 (95% CI, 0.09 to 0.27), respectively. CONCLUSIONS Chronic pain is common in CKD with a significant relationship between the severity of pain and both proper and improper analgesic usage. Screening for chronic pain may help in understanding the role of DRPs in the delivery of safe CKD care.
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Affiliation(s)
| | | | - Min Zhan
- Epidemiology and Public Health, School of Medicine, University of Maryland, Baltimore, Maryland; and
| | | | | | - Corinne Woods
- Department of Pharmaceutical Health Services Research, School of Pharmacy, University of Maryland, Baltimore
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Kondo N, Nakamura F, Yamazaki S, Yamamoto Y, Akizawa T, Akiba T, Saito A, Kurokawa K, Fukuhara S. Prescription of potentially inappropriate medications to elderly hemodialysis patients: prevalence and predictors. Nephrol Dial Transplant 2014; 30:498-505. [DOI: 10.1093/ndt/gfu070] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Pai AB, Cardone KE, Manley HJ, St Peter WL, Shaffer R, Somers M, Mehrotra R. Medication reconciliation and therapy management in dialysis-dependent patients: need for a systematic approach. Clin J Am Soc Nephrol 2013; 8:1988-99. [PMID: 23990162 DOI: 10.2215/cjn.01420213] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Patients with ESRD undergoing dialysis have highly complex medication regimens and disproportionately higher total cost of care compared with the general Medicare population. As shown by several studies, dialysis-dependent patients are at especially high risk for medication-related problems. Providing medication reconciliation and therapy management services is critically important to avoid costs associated with medication-related problems, such as adverse drug events and hospitalizations in the ESRD population. The Medicare Modernization Act of 2003 included an unfunded mandate stipulating that medication therapy management be offered to high-risk patients enrolled in Medicare Part D. Medication management services are distinct from the dispensing of medications and involve a complete medication review for all disease states. The dialysis facility is a logical coordination center for medication management services, like medication therapy management, and it is likely the first health care facility that a patient will present to after a care transition. A dedicated and adequately trained clinician, such as a pharmacist, is needed to provide consistent, high-quality medication management services. Medication reconciliation and medication management services that could consistently and systematically identify and resolve medication-related problems would be likely to improve ESRD patient outcomes and reduce total cost of care. Herein, this work provides a review of available evidence and recommendations for optimal delivery of medication management services to ESRD patients in a dialysis facility-centered model.
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Affiliation(s)
- Amy Barton Pai
- Department of Pharmacy Practice, ANephRx Albany Nephrology Pharmacy Group, Albany College of Pharmacy and Health Sciences, Albany, New York;, †Reach Medication Therapy Management, Dialysis Clinic, Inc., Albany, New York;, ‡Department of Pharmaceutical Care and Health Systems, College of Pharmacy, University of Minnesota, Minneapolis, Minnesota;, §US Renal Data System and Chronic Disease Research Group, Minneapolis, Minnesota;, ‖Policy and Government Affairs, American Society of Nephrology, Washington, DC;, ¶Division of Nephrology, Boston Children's Hospital, Boston, Massachusetts, *Division of Nephrology, Harborview Medical Center and Kidney Research Institute, University of Washington, Seattle, Washington
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