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Research

Potentially inappropriate prescribing in people with chronic kidney disease: cross-sectional analysis of a large population cohort

Clare Elizabeth MacRae, Stewart Mercer and Bruce Guthrie
British Journal of General Practice 14 December 2020; BJGP.2020.0871. DOI: https://doi.org/10.3399/BJGP.2020.0871
Clare Elizabeth MacRae
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  • For correspondence: clare.macrae@ed.ac.uk
Stewart Mercer
3 Usher institute, University of Edinburgh, Edinburgh, United Kingdom of Great Britain and Northern Ireland
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Bruce Guthrie
4 College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, United Kingdom of Great Britain and Northern Ireland
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Abstract

Background: Many drugs should be avoided or require dose-adjustment in chronic kidney disease (CKD). Previous estimates of potentially inappropriate prescribing rates have been based on data on a limited number of drugs and mainly in secondary care settings. Aim: To determine the prevalence of contraindicated and potentially inappropriate primary care prescribing in a complete population of people with CKD. Method: Cross-sectional study of prescribing patterns in a complete geographical population of people with CKD defined using laboratory data. Drugs were organised by British National Formulary advice. Contraindicated (CI) drugs: “avoid”. Potentially high risk (PHR) drugs: “avoid if possible”. Dose inappropriate (DI) drugs: dose exceeded recommended maximums. Results: 28,489 people with CKD were included in analysis, of whom 70.0% had CKD 3a, 22.4% CKD 3b, 5.9% CKD 4, and 1.5% CKD 5. 3.9% (95%CI 3.7-4.1) of people with CKD stages 3a-5 were prescribed one or more CI drug, 24.3% (95%CI 23.8-24.8) PHR drug, and 15.2% (95% CI 14.8-15.62) DI drug. CI drugs differed in prevalence by CKD stage, and were most commonly prescribed in CKD stage 4 with a prevalence of 36.0% (95%CI 33.7–38.2). PHR drugs were commonly prescribed in all CKD stages ranging from 19.4% (95%CI 17.6-21.3) in stage 4 to 25.1% (95%CI 24.5–25.7) in stage 3b. DI drugs were most commonly prescribed in stage 4, 26.4% (95%CI 24.3-28.6). Conclusion: Potentially inappropriate prescribing is common at all stages of CKD. Development and evaluation of interventions to improve prescribing safety in this high-risk populations are needed.

  • Clinical (general)
  • Complementary and alternative medicine (CAM)
  • Consultation skills
  • Continuity of care
  • Mental health
  • Depression
  • Received September 21, 2020.
  • Accepted November 23, 2020.
  • Copyright © 2020, The Authors

This article is Open Access: CC BY license (https://creativecommons.org/licenses/by/4.0/)

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Potentially inappropriate prescribing in people with chronic kidney disease: cross-sectional analysis of a large population cohort
Clare Elizabeth MacRae, Stewart Mercer, Bruce Guthrie
British Journal of General Practice 14 December 2020; BJGP.2020.0871. DOI: 10.3399/BJGP.2020.0871

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Accepted Manuscript
Potentially inappropriate prescribing in people with chronic kidney disease: cross-sectional analysis of a large population cohort
Clare Elizabeth MacRae, Stewart Mercer, Bruce Guthrie
British Journal of General Practice 14 December 2020; BJGP.2020.0871. DOI: 10.3399/BJGP.2020.0871
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Keywords

  • Clinical (general)
  • Complementary and alternative medicine (CAM)
  • Consultation skills
  • Continuity of care
  • Mental health
  • Depression

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Print ISSN: 0960-1643
Online ISSN: 1478-5242