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

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 - contraindicated drugs: 'avoid'; potentially high-risk (PHR) drugs: 'avoid if possible'; and dose-inappropriate (DI) drugs: 'dose exceeded recommended maximums'. CKD was defined as estimated glomerular filtration rate (eGFR) <= 60 ml/min/1.73 m(2) 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-5 were prescribed >= 1 contraindicated drug. 24.3% (95% CI = 23.8 to 24.8) >= 1 PHR drug, arid 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, wth a prevalence of 36.0% (95% CI = 33.7 to 38.2). PIER 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.

Automated summary

This study found that potentially inappropriate prescribing is common in all stages of CKD, especially in CKD stage 4. Development and evaluation of interventions to improve prescribing safety in this high-risk population are needed.