Abstract
BackgroundPeople with chronic kidney disease (CKD) have high levels of co-morbidity and polypharmacy placing them at increased risk of prescribing-related harm. Tools for assessing prescribing safety in the general population using prescribing safety indicators (PSIs) have been established. However, people with CKD pose different prescribing challenges to people without kidney disease. Therefore, PSIs designed for use in the general population may not include all PSIs relevant to a CKD population.The aim of this study was to systematically collate a library of PSIs relevant to people with CKD.MethodsA systematic literature search identified papers reporting PSIs. CKD-specific PSIs were extracted and categorised by Anatomical Therapeutic Chemical (ATC) classification codes. Duplicate PSIs were removed to create a final list of CKD-specific PSIs.ResultsNine thousand, eight hundred fifty-two papers were identified by the systematic literature search, of which 511 proceeded to full text screening and 196 papers were identified as reporting PSIs. Following categorisation by ATC code and duplicate removal, 841 unique PSIs formed the final set of CKD-specific PSIs. The five ATC drug classes containing the largest proportion of CKD-specific PSIs were: Cardiovascular system (26%); Nervous system (13.4%); Blood and blood forming organs (12.4%); Alimentary and metabolism (12%); and Anti-infectives for systemic use (11.3%).ConclusionCKD-specific PSIs could be used alone or alongside general PSIs to assess the safety and quality of prescribing within a CKD population.
Highlights
People with chronic kidney disease (CKD) have high levels of co-morbidity and polypharmacy placing them at increased risk of prescribing-related harm
Pre-defined criteria classified prescribing safety indicators (PSIs) as CKD-specific if they were of exclusive relevance to adults with CKD and referring to medications prescribed within the outpatient setting
In total 9852 papers were identified by the two searches (CKD search 5223; general population search 4629)
Summary
People with chronic kidney disease (CKD) have high levels of co-morbidity and polypharmacy placing them at increased risk of prescribing-related harm. People with chronic kidney disease (CKD) stand to benefit from careful prescribing of medications to prevent disease progression, manage comorbidities and relieve symptoms [1] They are at increased risk of prescribing-related harm as a result of incorrect dosing considering altered drug clearance or direct nephrotoxicity. One systematic approach to the identification of PSIs conducted by Spencer et al in 2012 collated 56 indicators relevant to the general primary care population [4]. Whilst such a library is applicable to a CKD population, prescribing events of unique importance to people with kidney disease may be inadequately represented when considering pharmacotherapy for this group in isolation
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