The Burden of Nephrotoxic Drug Prescriptions in Patients with Chronic Kidney Disease: A Retrospective Population-Based Study in Southern Italy

被引:49
作者
Ingrasciotta, Ylenia [1 ]
Sultana, Janet [1 ]
Giorgianni, Francesco [1 ]
Caputi, Achille Patrizio [1 ]
Arcoraci, Vincenzo [1 ]
Tari, Daniele Ugo [2 ]
Linguiti, Claudio [2 ]
Perrotta, Margherita [2 ]
Nucita, Andrea [3 ]
Pellegrini, Fabio [4 ]
Fontana, Andrea [4 ]
Cavagna, Lorenzo [5 ,6 ]
Santoro, Domenico [1 ]
Trifiro, Gianluca [1 ]
机构
[1] Univ Messina, Dept Clin & Expt Med, Messina, Italy
[2] Caserta Local Hlth Serv, Caserta, Italy
[3] Univ Messina, Dept Cognit Sci Educ & Cultural Studies CSECS, Messina, Italy
[4] IRCCS Casa Sollievo Sofferenza, Unit Biostat, San Giovanni Rotondo, FG, Italy
[5] Univ Pavia, Div Rheumatol, I-27100 Pavia, Italy
[6] IRCCS Fdn Policlin S Matteo, Pavia, Italy
来源
PLOS ONE | 2014年 / 9卷 / 02期
关键词
NONSTEROIDAL ANTIINFLAMMATORY DRUGS; PRESCRIBING PATTERN; GENERAL-PRACTICE; INTERACTION RISK; PREVALENCE; CARE; PROGRESSION; OUTCOMES; TRENDS;
D O I
10.1371/journal.pone.0089072
中图分类号
O [数理科学和化学]; P [天文学、地球科学]; Q [生物科学]; N [自然科学总论];
学科分类号
07 ; 0710 ; 09 ;
摘要
Background: The use of nephrotoxic drugs can further worsening renal function in chronic kidney disease (CKD) patients. It is therefore imperative to explore prescribing practices that can negatively affect CKD patients. Aim: To analyze the use of nephrotoxic drugs in CKD patients in a general population of Southern Italy during the years 2006-2011. Methods: The general practice "Arianna" database contains data from 158,510 persons, registered with 123 general practitioners (GPs) of Caserta. CKD patients were identified searching: CKD-related ICD-9 CM codes among causes of hospitalization; CKD-relevant procedures undergone in hospital (e.g. dialysis); drug prescriptions issued for a CKD-related indication. A list of nephrotoxic drugs was compiled and validated by pharmacologists and nephrologists. The summary of product characteristics was used to classify drugs as 'contraindicated' or 'to be used with caution' in renal diseases. Frequency of nephrotoxic drug use, overall, by drug class and single compounds, by GPs within one year prior or after first CKD diagnosis and within one year after dialysis entry was calculated. Results: Overall, 1,989 CKD patients and 112 dialysed patients were identified. Among CKD patients, 49.8% and 45.2% received at least one prescription for a contraindicated nephrotoxic drug within one year prior or after first CKD diagnosis, respectively. In detail, 1,119 CKD patients (56.3%) had at least one nonsteroidal anti-inflammatory drugs (NSAIDs) prescription between CKD diagnosis and end of follow-up. A large proportion of CKD patients (35.6%) were treated with NSAIDs for periods exceeding 90 days. Contraindicated nephrotoxic drugs were used commonly in CKD, with nimesulide (16.6%) and diclofenac (11.0%) being most frequently used. Conclusions: Contraindicated nephrotoxic drugs were highly prescribed in CKD patients from a general population of Southern Italy. CKD diagnosis did not seem to reduce significantly the prescription of nephrotoxic drugs, which may increase the risk of preventable renal function deterioration.
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页数:8
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