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Quality use of medicines in patients with chronic kidney disease.
BMC Nephrology ( IF 2.3 ) Pub Date : 2020-06-05 , DOI: 10.1186/s12882-020-01862-1
Ronald L Castelino 1, 2 , Timothy Saunder 3 , Alex Kitsos 4 , Gregory M Peterson 4 , Matthew Jose 5, 6 , Barbara Wimmer 7 , Masuma Khanam 8 , Woldesellassie Bezabhe 9 , Jim Stankovich 10 , Jan Radford 11
Affiliation  

Chronic kidney disease (CKD) affects drug elimination and patients with CKD require appropriate adjustment of renally cleared medications to ensure safe and effective pharmacotherapy. The main objective of this study was to determine the extent of potentially inappropriate prescribing (PIP; defined as the use of a contraindicated medication or inappropriately high dose according to the kidney function) of renally-cleared medications commonly prescribed in Australian primary care, based on two measures of kidney function. A secondary aim was to assess agreement between the two measures. Retrospective analysis of routinely collected de-identified Australian general practice patient data (NPS MedicineWise MedicineInsight from January 1, 2013, to June 1, 2016; collected from 329 general practices). All adults (aged ≥18 years) with CKD presenting to general practices across Australia were included in the analysis. Patients were considered to have CKD if they had two or more estimated glomerular filtration rate (eGFR) recorded values < 60 mL/min/1.73m2, and/or two urinary albumin/creatinine ratios ≥3.5 mg/mmol in females (≥2.5 mg/mmol in males) at least 90 days apart. PIP was assessed for 49 commonly prescribed medications using the Cockcroft-Gault (CG) equation/eGFR as per the instructions in the Australian Medicines Handbook. A total of 48,731 patients met the Kidney Health Australia (KHA) definition for CKD and had prescriptions recorded within 90 days of measuring serum creatinine (SCr)/estimated glomerular filtration rate (eGFR). Overall, 28,729 patients were prescribed one or more of the 49 medications of interest. Approximately 35% (n = 9926) of these patients had at least one PIP based on either the Cockcroft-Gault (CG) equation or eGFR (CKD-EPI; CKD-Epidemiology Collaboration Equation). There was good agreement between CG and eGFR while determining the appropriateness of medications, with approximately 97% of the medications classified as appropriate by eGFR also being considered appropriate by the CG equation. This study highlights that PIP commonly occurs in primary care patients with CKD and the need for further research to understand why and how this can be minimised. The findings also show that the eGFR provides clinicians a potential alternative to the CG formula when estimating kidney function to guide drug appropriateness and dosing.

中文翻译:

慢性肾脏病患者的药物质量使用。

慢性肾病 (CKD) 影响药物消除,CKD 患者需要适当调整肾脏清除药物,以确保安全有效的药物治疗。本研究的主要目的是确定澳大利亚初级保健中常用的肾清除药物的潜在不适当处方(PIP;定义为使用禁忌药物或根据肾功能不适当的高剂量)的程度,基于肾功能的两个指标。次要目的是评估两项措施之间的一致性。对常规收集的澳大利亚全科诊所患者数据(NPS MedicineWise MedicineInsight 从 2013 年 1 月 1 日至 2016 年 6 月 1 日;从 329 个全科诊所收集)进行回顾性分析。分析中包括在澳大利亚全科就诊的所有 CKD 成人(≥18 岁)。如果患者有两个或多个估计肾小球滤过率 (eGFR) 记录值 <60 mL/min/1.73m2,和/或两个尿白蛋白/肌酐比值≥3.5 mg/mmol 女性(≥男性 2.5 毫克/毫摩尔)至少相隔 90 天。根据澳大利亚药品手册中的说明,使用 Cockcroft-Gault (CG) 方程 / eGFR 评估了 49 种常用处方药的 PIP。共有 48,731 名患者符合澳大利亚肾脏健康 (KHA) 对 CKD 的定义,并且在测量血清肌酐 (SCr)/估计肾小球滤过率 (eGFR) 的 90 天内记录了处方。总体而言,28,729 名患者服用了 49 种感兴趣的药物中的一种或多种。根据 Cockcroft-Gault (CG) 方程或 eGFR(CKD-EPI;CKD-流行病学合作方程),这些患者中约有 35% (n = 9926) 至少有一个 PIP。在确定药物的适当性时,CG 和 eGFR 之间存在良好的一致性,大约 97% 被 eGFR 归类为适当的药物也被 CG 方程认为是合适的。这项研究强调了 PIP 通常发生在 CKD 的初级保健患者中,需要进一步研究以了解为什么以及如何将其最小化。研究结果还表明,在估计肾功能以指导药物适当性和剂量时,eGFR 为临床医生提供了 CG 公式的潜在替代方案。CKD-流行病学合作方程)。在确定药物的适当性时,CG 和 eGFR 之间存在良好的一致性,大约 97% 被 eGFR 归类为适当的药物也被 CG 方程认为是合适的。这项研究强调了 PIP 通常发生在 CKD 的初级保健患者中,需要进一步研究以了解为什么以及如何将其最小化。研究结果还表明,在估计肾功能以指导药物适当性和剂量时,eGFR 为临床医生提供了 CG 公式的潜在替代方案。CKD-流行病学合作方程)。在确定药物的适当性时,CG 和 eGFR 之间存在良好的一致性,大约 97% 被 eGFR 归类为适当的药物也被 CG 方程认为是合适的。这项研究强调了 PIP 通常发生在 CKD 的初级保健患者中,需要进一步研究以了解为什么以及如何将其最小化。研究结果还表明,在估计肾功能以指导药物适当性和剂量时,eGFR 为临床医生提供了 CG 公式的潜在替代方案。大约 97% 的药物被 eGFR 归类为合适的药物,也被 CG 方程认为是合适的。这项研究强调了 PIP 通常发生在 CKD 的初级保健患者中,需要进一步研究以了解为什么以及如何将其最小化。研究结果还表明,在估计肾功能以指导药物适当性和剂量时,eGFR 为临床医生提供了 CG 公式的潜在替代方案。大约 97% 的药物被 eGFR 归类为合适的药物,也被 CG 方程认为是合适的。这项研究强调了 PIP 通常发生在 CKD 的初级保健患者中,需要进一步研究以了解为什么以及如何将其最小化。研究结果还表明,在估计肾功能以指导药物适当性和剂量时,eGFR 为临床医生提供了 CG 公式的潜在替代方案。
更新日期:2020-06-05
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