Polypharmacy is common among patients with CKD, but little is known about the urinary excretion of many drugs and their metabolites among patients with CKD.

To evaluate self-reported medication use in relation to urine drug metabolite levels in a large cohort of patients with CKD, the German Chronic Kidney Disease study, we ascertained self-reported use of 158 substances and 41 medication groups, and coded active ingredients according to the Anatomical Therapeutic Chemical Classification System. We used a nontargeted mass spectrometry–based approach to quantify metabolites in urine; calculated specificity, sensitivity, and accuracy of medication use and corresponding metabolite measurements; and used multivariable regression models to evaluate associations and prescription patterns.

Among 4885 participants, there were 108 medication-drug metabolite pairs on the basis of reported medication use and 78 drug metabolites. Accuracy was excellent for measurements of 36 individual substances in which the unchanged drug was measured in urine (median, 98.5%; range, 61.1%–100%). For 66 pairs of substances and their related drug metabolites, median measurement-based specificity and sensitivity were 99.2% (range, 84.0%–100%) and 71.7% (range, 1.2%–100%), respectively. Commonly prescribed medications for hypertension and cardiovascular risk reduction—including angiotensin II receptor blockers, calcium channel blockers, and metoprolol—showed high sensitivity and specificity. Although self-reported use of prescribed analgesics (acetaminophen, ibuprofen) was <3% each, drug metabolite levels indicated higher usage (acetaminophen, 10%–26%; ibuprofen, 10%–18%).

This comprehensive screen of associations between urine drug metabolite levels and self-reported medication use supports the use of pharmacometabolomics to assess medication adherence and prescription patterns in persons with CKD, and indicates under-reported use of medications available over the counter, such as analgesics.

CKD 患者多药治疗很常见，但对许多药物及其代谢物在 CKD 患者的尿液排泄情况知之甚少。

为了评估大量 CKD 患者自我报告的药物使用与尿液药物代谢物水平的关系，德国慢性肾脏病研究确定了自我报告的 158 种物质和 41 个药物组的使用情况，并根据解剖治疗化学分类系统。我们使用基于非靶向质谱的方法来量化尿液中的代谢物；计算药物使用和相应代谢物测量的特异性、敏感性和准确性；并使用多变量回归模型来评估关联和处方模式。

在 4885 名参与者中，有 108 对药物-药物代谢物基于报告的用药情况和 78 种药物代谢物。对 36 种单独物质的测量精度非常好，其中在尿液中测量了未变化的药物（中位数，98.5%；范围，61.1%–100%）。对于 66 对物质及其相关药物代谢物，基于测量的特异性和敏感性中值分别为 99.2%（范围，84.0%–100%）和 71.7%（范围，1.2%–100%）。用于高血压和降低心血管风险的常用处方药——包括血管紧张素 II 受体阻滞剂、钙通道阻滞剂和美托洛尔——显示出高敏感性和特异性。尽管自我报告的处方镇痛药（对乙酰氨基酚、布洛芬）的使用率均低于 3%，但药物代谢物水平表明使用率更高（对乙酰氨基酚，10%–26%；

这种尿液药物代谢物水平与自我报告的药物使用之间关联的全面筛查支持使用药物代谢组学来评估 CKD 患者的药物依从性和处方模式，并表明非处方药（如止痛药）的使用报告不足。