Kidney Disease Management in the Hospital Setting: A Focus on Inappropriate Drug Prescriptions in Older Patients.

Vincenzo Arcoraci,Giuseppe Natoli,On Behalf Of The Reposi Investigators ,Christiano Argano,Giovanni Squadrito,Alessandro Nobili,Michelangelo Rottura,Salvatore Corrao,Maria Antonietta Barbieri,Francesco Squadrito

doi:10.3389/fphar.2021.749711

Abstract

Aging with multimorbidity and polytherapy are the most significant factors that could led to inappropriate prescribing of contraindicated medications in patients with chronic kidney disease (CKD). The aim of this study was to evaluate the prescriptions of contraindicated drugs in older adults in CKD and to identify their associated factors in a hospital context. An observational retrospective study was carried out considering all patients ≥65 years with at least one serum creatinine value recorded into the REPOSI register into 2010–2016 period. The estimated glomerular filtration rate (eGFR) was applied to identify CKD. A descriptive analysis was performed to compare demographic and clinical characteristics; logistic regression models were used to estimate factors of inappropriate and percentage changes of drug use during hospitalization. A total of 4,713 hospitalized patients were recorded, of which 49.8% had an eGFR <60 ml/min/1.73 m2; the 21.9% were in treatment with at least one inappropriate drug at the time of hospital admission with a decrease of 3.0% at discharge (p = 0.010). The probability of using at least one contraindicated drug was significantly higher in patients treated with more several drugs (OR 1.21, 95% CI 1.16–1.25, p <0.001) and with CKD end-stages (G4: 16.90, 11.38–25.12, p < 0.001; G5: 19.38, 11.51–32.64, p < 0.001). Low-dose acetylsalicylic acid was the contraindicated drug mainly used at the time of admission, reducing 1.2% at discharge. An overall increase in therapeutic appropriateness in hospitalized older patients with CKD was observed, despite a small percentage of therapeutic inappropriateness at discharge that underlines the need for a closer collaboration with the pharmacologist to improve the drug management.

Highlights

Chronic kidney disease (CKD) is considered one of the most serious public health problems in the world (Genovese et al, 2018; Ammirati, 2020)
For the reasons described above, this study aimed to evaluate the prescriptions of nephrotoxic and contraindicated drugs in older patients with glomerular filtration rate (GFR)
The REgistro POliterapie SIMI (REPOSI) is a multicenter collaborative observational registry cooperatively established by the Italian Society of Internal Medicine (SIMI), IRCCS Ca’ Granda Maggiore Policlinico Hospital Foundation and Mario Negri Institute of Pharmacological Research IRCCS that was made up to recruit, monitor and evaluate hospitalized older adults ≥65 years admitted to 102 Italian internal medicine and geriatric wards with data came from each single medical record and collected every 2 years from 2008 onwards (Nobili et al, 2011; Argano et al, 2020)

Summary

Introduction

Chronic kidney disease (CKD) is considered one of the most serious public health problems in the world (Genovese et al, 2018; Ammirati, 2020). The prevalence of CKD is estimated as 9.1% worldwide, and, in detail, stage G3 accounts for 3.9%, stage G4 for 0.2%, and stage G5 for 0.1% (Bikbov et al, 2020). It is widely known that kidney disease is one of the most comorbid conditions in older adults, with an overall estimated prevalence ranging from 21.4 to 47.0% and with an incidence rate of stage G4 that rises with older age (Matsushita et al, 2010; Amaral et al, 2019; Ravani et al, 2020). The presence of CKD could be associated with several comorbidities, including hypertension, diabetes, chronic respiratory and cardiovascular disorders (Fox et al, 2012; Mahmoodi et al, 2014; Fraser et al, 2015)

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