Inappropriate prescribing in chronic kidney disease

A systematic review of prevalence, associated clinical outcomes and impact of interventions

Wubshet Hailu Tesfaye, Ronald L Castelino, Barbara C Wimmer, Syed Tabish R Zaidi

Research output: Contribution to journalSystematic Review

12 Citations (Scopus)

Abstract

INTRODUCTION: Adjusting doses of renally cleared medications and/or avoidance of nephrotoxic medications are standard clinical practices in chronic kidney disease (CKD), albeit the prevalence of inappropriate prescribing (IP) in these patients remains high. Therefore, this work sought to systematically review the prevalence of IP and compare the relative effectiveness of available interventions in reducing IP in CKD.

METHODS: Studies were identified searching PubMed/Medline, EMBASE, Cochrane Library, IPA, Web of Science, Ovid/Medline, CINAHL, and PsychINFO databases. Studies defining CKD based on laboratory markers and quantifying prevalence of IP were included.

RESULTS: Forty-nine studies from 23 countries met the inclusion criteria. An IP prevalence of 9.4%-81.1% and 13%-80.50% was reported in hospital and ambulatory settings, respectively; whereas, in long-term care facilities the prevalence ranged between 16% and 37.9%. Unsurprisingly, IP was associated with adverse drug events like increased hospital stay (Mean [SD] of 4.5 [4.8] vs 4.3 [4.5]) and high risk of mortality [40%]. Twenty-one studies reported the impact of interventions on IP; manual and computerised alerts were the main forms of interventions (n=19). The most significant reduction in IP was observed when physicians received immediate concurrent feedback from a clinical pharmacist (P<.001). Polypharmacy, comorbidities, and age were identified as predictors of IP.

CONCLUSION: IP has led to poor patient outcomes. Although pharmacist-based and computer-aided approaches have shown promising results, there is still room for improvement. Future studies should focus on developing a multifaceted intervention to address the widespread prevalence of IP and associated clinical outcomes in CKD patients.

Original languageEnglish
Article numbere12960
Pages (from-to)1-16
Number of pages16
JournalInternational Journal of Clinical Practice
Volume71
Issue number7
DOIs
Publication statusPublished - Jul 2017
Externally publishedYes

Fingerprint

Inappropriate Prescribing
Chronic Renal Insufficiency
Pharmacists
Polypharmacy
Long-Term Care
Drug-Related Side Effects and Adverse Reactions
PubMed
Libraries
Comorbidity
Length of Stay

Cite this

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title = "Inappropriate prescribing in chronic kidney disease: A systematic review of prevalence, associated clinical outcomes and impact of interventions",
abstract = "INTRODUCTION: Adjusting doses of renally cleared medications and/or avoidance of nephrotoxic medications are standard clinical practices in chronic kidney disease (CKD), albeit the prevalence of inappropriate prescribing (IP) in these patients remains high. Therefore, this work sought to systematically review the prevalence of IP and compare the relative effectiveness of available interventions in reducing IP in CKD.METHODS: Studies were identified searching PubMed/Medline, EMBASE, Cochrane Library, IPA, Web of Science, Ovid/Medline, CINAHL, and PsychINFO databases. Studies defining CKD based on laboratory markers and quantifying prevalence of IP were included.RESULTS: Forty-nine studies from 23 countries met the inclusion criteria. An IP prevalence of 9.4{\%}-81.1{\%} and 13{\%}-80.50{\%} was reported in hospital and ambulatory settings, respectively; whereas, in long-term care facilities the prevalence ranged between 16{\%} and 37.9{\%}. Unsurprisingly, IP was associated with adverse drug events like increased hospital stay (Mean [SD] of 4.5 [4.8] vs 4.3 [4.5]) and high risk of mortality [40{\%}]. Twenty-one studies reported the impact of interventions on IP; manual and computerised alerts were the main forms of interventions (n=19). The most significant reduction in IP was observed when physicians received immediate concurrent feedback from a clinical pharmacist (P<.001). Polypharmacy, comorbidities, and age were identified as predictors of IP.CONCLUSION: IP has led to poor patient outcomes. Although pharmacist-based and computer-aided approaches have shown promising results, there is still room for improvement. Future studies should focus on developing a multifaceted intervention to address the widespread prevalence of IP and associated clinical outcomes in CKD patients.",
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Inappropriate prescribing in chronic kidney disease : A systematic review of prevalence, associated clinical outcomes and impact of interventions. / Tesfaye, Wubshet Hailu; Castelino, Ronald L; Wimmer, Barbara C; Zaidi, Syed Tabish R.

In: International Journal of Clinical Practice, Vol. 71, No. 7, e12960, 07.2017, p. 1-16.

Research output: Contribution to journalSystematic Review

TY - JOUR

T1 - Inappropriate prescribing in chronic kidney disease

T2 - A systematic review of prevalence, associated clinical outcomes and impact of interventions

AU - Tesfaye, Wubshet Hailu

AU - Castelino, Ronald L

AU - Wimmer, Barbara C

AU - Zaidi, Syed Tabish R

N1 - © 2017 John Wiley & Sons

PY - 2017/7

Y1 - 2017/7

N2 - INTRODUCTION: Adjusting doses of renally cleared medications and/or avoidance of nephrotoxic medications are standard clinical practices in chronic kidney disease (CKD), albeit the prevalence of inappropriate prescribing (IP) in these patients remains high. Therefore, this work sought to systematically review the prevalence of IP and compare the relative effectiveness of available interventions in reducing IP in CKD.METHODS: Studies were identified searching PubMed/Medline, EMBASE, Cochrane Library, IPA, Web of Science, Ovid/Medline, CINAHL, and PsychINFO databases. Studies defining CKD based on laboratory markers and quantifying prevalence of IP were included.RESULTS: Forty-nine studies from 23 countries met the inclusion criteria. An IP prevalence of 9.4%-81.1% and 13%-80.50% was reported in hospital and ambulatory settings, respectively; whereas, in long-term care facilities the prevalence ranged between 16% and 37.9%. Unsurprisingly, IP was associated with adverse drug events like increased hospital stay (Mean [SD] of 4.5 [4.8] vs 4.3 [4.5]) and high risk of mortality [40%]. Twenty-one studies reported the impact of interventions on IP; manual and computerised alerts were the main forms of interventions (n=19). The most significant reduction in IP was observed when physicians received immediate concurrent feedback from a clinical pharmacist (P<.001). Polypharmacy, comorbidities, and age were identified as predictors of IP.CONCLUSION: IP has led to poor patient outcomes. Although pharmacist-based and computer-aided approaches have shown promising results, there is still room for improvement. Future studies should focus on developing a multifaceted intervention to address the widespread prevalence of IP and associated clinical outcomes in CKD patients.

AB - INTRODUCTION: Adjusting doses of renally cleared medications and/or avoidance of nephrotoxic medications are standard clinical practices in chronic kidney disease (CKD), albeit the prevalence of inappropriate prescribing (IP) in these patients remains high. Therefore, this work sought to systematically review the prevalence of IP and compare the relative effectiveness of available interventions in reducing IP in CKD.METHODS: Studies were identified searching PubMed/Medline, EMBASE, Cochrane Library, IPA, Web of Science, Ovid/Medline, CINAHL, and PsychINFO databases. Studies defining CKD based on laboratory markers and quantifying prevalence of IP were included.RESULTS: Forty-nine studies from 23 countries met the inclusion criteria. An IP prevalence of 9.4%-81.1% and 13%-80.50% was reported in hospital and ambulatory settings, respectively; whereas, in long-term care facilities the prevalence ranged between 16% and 37.9%. Unsurprisingly, IP was associated with adverse drug events like increased hospital stay (Mean [SD] of 4.5 [4.8] vs 4.3 [4.5]) and high risk of mortality [40%]. Twenty-one studies reported the impact of interventions on IP; manual and computerised alerts were the main forms of interventions (n=19). The most significant reduction in IP was observed when physicians received immediate concurrent feedback from a clinical pharmacist (P<.001). Polypharmacy, comorbidities, and age were identified as predictors of IP.CONCLUSION: IP has led to poor patient outcomes. Although pharmacist-based and computer-aided approaches have shown promising results, there is still room for improvement. Future studies should focus on developing a multifaceted intervention to address the widespread prevalence of IP and associated clinical outcomes in CKD patients.

KW - Humans

KW - Inappropriate Prescribing/adverse effects

KW - Renal Insufficiency, Chronic/drug therapy

KW - Treatment Outcome

KW - Urological Agents/adverse effects

U2 - 10.1111/ijcp.12960

DO - 10.1111/ijcp.12960

M3 - Systematic Review

VL - 71

SP - 1

EP - 16

JO - British Journal of Clinical Practice

JF - British Journal of Clinical Practice

SN - 1368-5031

IS - 7

M1 - e12960

ER -