Potentially inappropriate medication linked to three adverse results for patients with CKD
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Use of potentially inappropriate medications, as defined by the American Geriatrics Society Beers Criteria, was linked to an increased risk for hospitalizations, falls and mortality in adults with chronic kidney disease.
However, exposure to the drugs — which included proton pump inhibitors, alpha blockers, NSAIDs, psychoactives and central alpha agonists — was not associated with either CKD progression or kidney failure.
“While some studies have shown [potentially inappropriate medications] PIMs are common in older adults with CKD, it is paramount to understand if PIMs independently contribute to adverse outcomes in the CKD population,” Rasheeda K. Hall, MD, MBA, MHS, of Duke University School of Medicine, and colleagues wrote. “With that information, providers will have additional guidance for PIM prescribing decisions.”
To investigate, Hall and colleagues examined data related to 3,929 individuals who were enrolled in the Chronic Renal Insufficiency Cohort study. Participant age ranged from 21 years to 74 years, with a mean age of 58 years (mean age for the sub-analysis related to frailty was 63 years).
In total, 80% of the cohort had a history of PIM use, with researchers finding use was more likely in older patients, women, Black patients, and individuals with a BMI of more than 30 kg/m2 or who had cardiovascular disease, arthritis or lower urine protein-creatine ratios. The most commonly prescribed PIMs were proton pump inhibitors and alpha blockers.
Considering the independent association between PIMs and adverse outcomes 1 year following PIM exposure, results of unadjusted analyses showed any PIM use was associated with an increased likelihood of hospitalizations, mortality and falls compared with no use.
After adjustments were made, researchers observed a graded association between increasing number of PIMs and a higher hospitalization rate (relative ratios of 1.09, 1.18 and 1.35 for one, two, or three or more PIMs, respectively).
Similarly, the odds of mortality increased with additional PIMs (odds ratios were 1.19, 1.62 and 1.65, respectively).
Prescriptions for three or more PIMs were also associated with an increased fall risk (adjusted OR = 2.85), according to a sub-analysis of 1,109 participants who reported falls during the study period.
“Older age did not increase the strength of association of PIMs with adverse outcomes; however, adults aged [younger than 65 years] with at least one PIM (compared to similarly aged cohort members without PIM exposure) had increased risk of death within a year,” Hall and colleagues wrote. “These findings suggest additional evidence is needed to guide prescribing of PIMs in the general adult CKD population regardless of age to both minimize adverse outcomes and optimally manage comorbid conditions.”
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