Study: Adverse drug reactions common, many deemed preventable, in patients with CKD
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A study conducted in France found adverse drug reactions were common in patients with chronic kidney disease, most notably due antithrombotic agents, but researchers suggested many of these reactions may be preventable.
While drug-related nephrotoxicity is a frequent and well-documented issue for patients with CKD, an understudied area involves medications and toxic metabolites that accumulate in the kidneys and can lead to adverse drug reactions as kidney function declines, according to Solène M. Laville, of Paris-Saclay University, and colleagues.
“Despite impaired pharmacokinetics and pharmacodynamics, patients with CKD use multiple medicines and are often exposed to some that are inappropriately prescribed,” the researchers wrote in their study. “Until now, studies in patients with CKD have been on the basis of self-reported [adverse drug reactions] ADRs, have concerned specific drugs during clinical trials, or have been restricted to ADRs during hospitalization, or to specific types of ADRs.”
To gain a more comprehensive understanding of adverse drug reactions in patients with reduced kidney function, the researchers included 3,3033 patients from the Chronic Kidney Disease-Renal Epidemiology and Information Network study (55% had eGFR 30 mL/min/1.73m2; 45% had eGFR <30 mL/min/1.73m2). Adverse drug reactions were identified from hospitalization reports, medical records and patient interviews, and patients were followed for 2 years. Patients were prescribed a median of eight medications.
During follow-up, 536 patients had 751 adverse drug reactions (14.4 per 100 person-years), with 150 of these reactions considered serious (defined here as causing mortality, hospitalization, disability or permanent damage).
The researchers found 16 reactions caused death, directly or indirectly. Further findings indicated that together renin-angiotensin system inhibitors, antithrombotic agents and diuretics led to most of the adverse reactions (15%, 14% and 10%, respectively), with antithrombotic agents causing 34% of serious adverse drug reactions.
In addition, patients with an eGFR of less than 30 mL/min/1.732, as well as those who were prescribed more than 10 medications, were significantly more likely to have a serious adverse drug reaction than those with higher eGFRs or who were prescribed fewer than five medications (adjusted hazard ratios of 1.8 and 2.4, respectively).
Among the serious adverse drug reactions, Laville and colleagues considered 32% preventable or potentially preventable, as measured on a seven-item preventability scale.
“[This study] shows that three drug classes among those most prescribed in this population are responsible for almost 40% of ADRs,” the researchers emphasized, adding that it is crucial the medical community be aware of the importance of eGFR level when prescribing medications.
They also called for increased involvement of pharmacists in verifying eGFR for patient prescriptions and enhanced patient education.
“The effect of ADRs on health resources and patients’ quality of life requires further evaluation,” they concluded.
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