@article {MacRaee483, author = {Clare MacRae and Stewart Mercer and Bruce Guthrie}, title = {Potentially inappropriate primary care prescribing in people with chronic kidney disease: a cross-sectional analysis of a large population cohort}, volume = {71}, number = {708}, pages = {e483--e490}, year = {2021}, 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 known CKD.Design and setting Cross-sectional study of prescribing patterns in a complete geographical population of people with CKD, defined using laboratory data.Method Drugs were organised by British National Formulary advice {\textemdash} contraindicated drugs: {\textquoteleft}avoid{\textquoteright}; potentially high-risk (PHR) drugs: {\textquoteleft}avoid if possible{\textquoteright}; and dose-inappropriate (DI) drugs: {\textquoteleft}dose exceeded recommended maximums{\textquoteright}. CKD was defined as estimated glomerular filtration rate (eGFR) <=60 ml/min/1.73 m2 for \>3 months.Results In total, 28 489 people with CKD were included in the analysis, of whom 70.1\% had CKD stage 3a, 22.4\% CKD stage 3b, 5.9\% CKD stage 4, and 1.5\% CKD stage 5. A total of 3.9\% (95\% confidence interval [CI] = 3.7 to 4.1) of people with CKD stages 3a{\textendash}5 were prescribed >=1 contraindicated drug, 24.3\% (95\% CI = 23.8 to 24.8) >=1 PHR drug, and 15.2\% (95\% CI = 14.8 to 15.6) >=1 DI drug. Contraindicated 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 to 38.2). PHR drugs were commonly prescribed in all CKD stages, ranging from 19.4\% (95\% CI = 17.6 to 21.3) in CKD stage 4 to 25.1\% (95\% CI = 24.5 to 25.7) in CKD stage 3a. DI drugs were most commonly prescribed in CKD stage 4 (26.4\%, 95\% CI = 24.3 to 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 population are needed.}, issn = {0960-1643}, URL = {https://bjgp.org/content/71/708/e483}, eprint = {https://bjgp.org/content/71/708/e483.full.pdf}, journal = {British Journal of General Practice} }