Evaluation of the adequacy of drug prescriptions in patients with chronic kidney disease: results from the CKD-REIN cohort
2018
Laville, Solène, M | Metzger, Marie | Stengel, Bénédicte | Jacquelinet, Christian | Combe, Christian | Fouque, Denis | Laville, Maurice | Frimat, Luc | Ayav, Carole | Speyer, Elodie | Robinson, Bruce, M | Massy, Ziad, A | Liabeuf, Sophie | Choukroun, Gabriel | Centre de recherche en épidémiologie et santé des populations (CESP) ; Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Saclay | Agence de la biomédecine [Saint-Denis la Plaine] | Centre Hospitalier Universitaire de Bordeaux (CHU Bordeaux) | INSERM U1026 (INSERM, U1026) ; Institut National de la Santé et de la Recherche Médicale (INSERM) | Centre Hospitalier Lyon Sud [CHU - HCL] (CHLS) ; Hospices Civils de Lyon (HCL) | Cardiovasculaire, métabolisme, diabétologie et nutrition (CarMeN) ; Institut National de la Recherche Agronomique (INRA)-Université Claude Bernard Lyon 1 (UCBL) ; Université de Lyon-Université de Lyon-Institut National des Sciences Appliquées de Lyon (INSA Lyon) ; Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM) | Service de Néphrologie [CHRU Nancy] ; Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy) | Centre d'investigation clinique - Epidémiologie clinique [Nancy] (CIC-EC) ; Centre d'investigation clinique [Nancy] (CIC) ; Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL)-Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL) | Arbor Research Collaborative for Health | Service Néphrologie/Dialyse [AP-HP Ambroise-Paré] ; Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Ambroise Paré [AP-HP] | CHU Amiens-Picardie | Mécanismes physiopathologiques et conséquences des calcifications cardiovasculaires - UR UPJV 7517 (MP3CV) ; Université de Picardie Jules Verne (UPJV)-CHU Amiens-Picardie | Chronic Kidney Disease - Réseau Epidémiologie et Information en Néphrologie (CKD REIN) ; Institut National de la Santé et de la Recherche Médicale (INSERM) | ANR-10-COHO-0001,CKD-REIN,Maladie Rénale Chronique - Réseau Epidémiologie et Information en Néphrologie(2010)
International audience
اظهر المزيد [+] اقل [-]إنجليزي. Aims Drug prescription is difficult to manage in patients with chronic kidney disease (CKD). We assessed the prevalence and determinants of inappropriate drug prescriptions (whether contraindications or inappropriately high doses) with regard to kidney function in patients with CKD under nephrology care. We also assessed the impact of the equation used to estimate GFR on the prevalence estimates. Methods Results The CKD-REIN cohort includes 3033 outpatients with CKD (eGFR between 15 and 60 ml min(-1) 1.73 m(-2)). We examined the daily doses of pharmacological agents prescribed at study entry. Inappropriate prescription was defined as the reported prescription of either a contraindicated drug or an indicated drug at an inappropriately high dose level with regard to the patient's GFR, as estimated with the CKD-EPI equation, the de-indexed CKD-EPI equation, or the Cockcroft-Gault (CG) equation. Multivariate logistic regression was used to assess the determinants of inappropriate prescription risk. At baseline, patients' median [interquartile range] number of drugs prescribed per patient was 8 [5-10]. Half of the patients had been prescribed at least one inappropriate drug. Anti-gout, cardiovascular agents and antidiabetic agents accounted for most of the inappropriate prescriptions. The percentage of inappropriate prescriptions varied from one GFR equation to another: 52% when using the CKD-EPI equation, 47% when using the de-indexed CKD-EPI equation and 41% with the CG equation. A multiple logistic regression analysis showed significantly higher odds ratios [95% confidence interval] for inappropriate prescriptions in male patients (1.28 [1.07; 1.53]), patients with diabetes (1.34 [1.06; 1.70]), those with a high BMI (1.58 [1.25; 1.99]), and those with a low GFR (10.2 [6.02; 17.3]). The risk of having at least one inappropriate prescription increased with the number of drugs per patient (P for trend \textless 0.0001) and therefore the odds ratio was 5.88 [4.17; 8.28] for those who received at least 11 prescribed medications compared to those who received fewer than 5. Conclusion Appendix Our results emphasize the complexity of drug management for CKD patients, for whom inappropriate prescription appears to be common.
اظهر المزيد [+] اقل [-]الكلمات المفتاحية الخاصة بالمكنز الزراعي (أجروفوك)
المعلومات البيبليوغرافية
تم تزويد هذا السجل من قبل Institut national de la recherche agronomique