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Erschienen in:
02.12.2019 | Original Research
Use of Potentially Nephrotoxic Medications by U.S. Adults with Chronic Kidney Disease: NHANES, 2011–2016
Erschienen in: Journal of General Internal Medicine | Ausgabe 4/2020
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Background
People with chronic kidney disease (CKD) are at risk for adverse events and/or CKD progression with use of renally eliminated or nephrotoxic medications.
Objective
To examine the prevalence of potentially inappropriate medication (PIM) use by U.S. adults by CKD stage and self-reported CKD awareness.
Design
Cross-sectional analysis of National Health and Nutrition Examination Surveys, 2011–2016
Participants
Non-pregnant adults with stages 3a (eGFR 45–59 mL/min/1.73 m2), 3b (eGFR 30–44), or 4–5 (eGFR < 30) CKD, stratified as CKD-aware/unaware.
Main Measures
PIMs were identified on the basis of KDIGO guidelines, label information, and literature review. We calculated proportions using any and individual PIMs, assessing for differences over CKD awareness within each CKD stage. Analyses were adjusted for age, sex, race/ethnicity, education, comorbidities, and insurance type.
Key Results
Adjusted proportions of U.S. adults taking any PIM(s) exceeded 50% for all CKD stages and awareness categories, and were highest among CKD-unaware patients with stages 4–5 CKD: 66.6% (95% CI, 55.5–77.8). Proton pump inhibitors, opioids, metformin, sulfonylureas, and non-steroidal anti-inflammatory drugs (NSAIDs) were all used frequently across CKD stages. NSAIDs were used less frequently when CKD-aware by patients with stage 3a CKD (2.2% [95% CI, − 0.3 to 4.7] vs. 10.7% [95% CI, 7.6 to 13.8]) and stages 4–5 CKD (0.8% [95% CI, − 0.9 to 2.5] vs. 16.5% [95% CI, 4.0 to 29.0]). Metformin was used less frequently when CKD-aware by patients with stage 3b CKD (8.1% [95% CI, 0.3–15.9] vs. 26.5% [95% CI, 17.4–35.7]) and stages 4–5 CKD (none vs. 20.8% [95% CI, 1.8–39.8]). The impact of CKD awareness was statistically significant after correction for multiple comparisons only for NSAIDs in stage 3a CKD.
Conclusions
PIMs are frequently used by people with CKD, with some impact of CKD awareness on NSAID and metformin use. This may lead to adverse outcomes or hasten CKD progression, reinforcing the need for improved medication management among people with CKD.