@article {MacRaeBJGP.2020.0871, author = {Clare Elizabeth MacRae and Stewart Mercer and Bruce Guthrie}, title = {Potentially inappropriate prescribing in people with chronic kidney disease: cross-sectional analysis of a large population cohort}, elocation-id = {BJGP.2020.0871}, year = {2020}, doi = {10.3399/BJGP.2020.0871}, publisher = {Royal College of General Practitioners}, 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: {\textquotedblleft}avoid{\textquotedblright}. Potentially high risk (PHR) drugs: {\textquotedblleft}avoid if possible{\textquotedblright}. 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{\textendash}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{\textendash}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.}, issn = {0960-1643}, URL = {https://bjgp.org/content/early/2020/12/13/BJGP.2020.0871}, eprint = {https://bjgp.org/content/early/2020/12/13/BJGP.2020.0871.full.pdf}, journal = {British Journal of General Practice} }