Abstract
Nephrotoxic drugs prescriptions are often prescribed inappropriately by general practitioners (GPs), increasing the risk of chronic kidney disease (CKD). The aim of this study was to detect inappropriate prescriptions in patients with CKD and to identify their predictive factors. A retrospective study on patients with creatinine values recorded in the period 2014–2016 followed by 10 GPs was performed. The estimated glomerular filtration rate (eGFR) was used to identify CKD patients. The demographic and clinical characteristics and drugs prescriptions were collected. A descriptive analysis was conducted to compare the characteristics and logistic regression models to estimate the predictive factors of inappropriate prescriptions. Of 4098 patients with creatinine values recorded, 21.9% had an eGFR <60 mL/min/1.73 m2. Further, 56.8% received inappropriate prescriptions, with a significantly lower probability in subjects with at least a nephrologist visit (Adj OR 0.54 (95% CI 0.36–0.81)) and a greater probability in patients treated with more active substances (1.10 (1.08–1.12)), affected by more comorbidities (1.14 (1.06–1.230)), or with serious CKD (G4/G5 21.28 (7.36–61.57)). Nonsteroidal anti-inflammatory drugs (NSAIDs) were the most used contraindicated drugs (48.5%), while acetylsalicylic acid was the most inappropriately prescribed (39.5%). Our results highlight the inappropriate prescriptions for CKD authorized by GPs and underline the need of strategies to improve prescribing patterns.
Highlights
Chronic kidney disease (CKD) is one of the most widespread diseases and it is deemed to be a real public health problem worldwide [1]
A total of 13,971 patients were followed by 10 general practitioners (GPs) of which 4098 (29.3%) had at least a registered serum creatinine value in the last three years with a high variability among each single GP. estimated glomerular filtration rate (eGFR) values were calculated by using the chronic kidney disease (CKD)-EPI formula: 3202 subjects (78.1%) had an eGFR of 60 mL/min or more
Only in 29.6% of them did GPs record the diagnosis of CKD during the study period, and only 25.5% of CKD patients were referred to a nephrologist
Summary
Chronic kidney disease (CKD) is one of the most widespread diseases and it is deemed to be a real public health problem worldwide [1]. CKD is defined as deficits in the kidney structure or function that persist for at least three months with consequences for the sufferer’s health. CKD is classified into stages based on glomerular filtration rate (GFR) values and albuminuria measurements, including the albumin excretion rate (AER) and the albumin-to-creatinine ratio (ACR). CKD has an estimated global prevalence of between 11% and 13%, mainly related to stages G3a and G3b [4]. The Italian prevalence of CKD is accounted for in 8.1% of men and 7.8% of women, despite advanced age and an unfavorable cardiovascular risk [7,8]. The percentage change in age-standardized rates between 1990 and 2017 was −9.2% in Italy compared with −2.7% registered in Central Europe [9]
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