Self-Reported Medication Use and Urinary Drug Metabolites in the German Chronic Kidney Disease (GCKD) Study

2021 ◽  
pp. ASN.2021010063
Author(s):  
Fruzsina Kotsis ◽  
Ulla Schultheiss ◽  
Matthias Wuttke ◽  
Pascal Schlosser ◽  
Johanna Mielke ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Anatomical Therapeutic Chemical ◽  
Medication Use ◽  
Cardiovascular Risk Reduction ◽  
Prescription Patterns ◽  
Drug Metabolites ◽  
Drug Metabolite ◽  
Specificity And Sensitivity ◽  
Urine Drug

Background Polypharamacy is common among patients with chronic kidney disease (CKD), but little is known about urinary excretion of many drugs and their metabolites among CKD patients. Methods To evaluate self-reported medication use in relation to urine drug metabolite levels in a large cohort of CKD patients, the Germany Chronic Kidney Disease study, we ascertained self-reported use of 158 substances and 41 medication groups and coded active ingredients according to the Anatomical Therapeutic Chemical classification system. We used a nontargeted mass spectrometry-based approach to quantify metabolites in urine; calculated specificity, sensitivity, and accuracy of medication use and corresponding metabolite measurements; and used multivariable regression models to evaluate associations and prescription patterns. Results Among 4885 participants, there were 108 medication-drug metabolite pairs based on reported medication use and 78 drug metabolites. Accuracy was excellent for measurements of 36 individual substances in which the unchanged drug was measured in urine (median, 98.5%; range 61.1%-100%). For 66 pairs of substances and their related drug metabolites, median measurement-based specificity and sensitivity were 99.2% (range 84.0%-100%) and 71.7% (range 1.2%-100%), respectively. Commonly prescribed medications for hypertension and cardiovascular risk reduction—including angiotensin-II receptor blockers, calcium channel blockers, and metoprolol—showed high sensitivity and specificity. Although self-reported use of prescribed analgesics (acetaminophen, ibuprofen) was <3% each, drug metabolite levels indicated higher usage (acetaminophen, 10%-26%; ibuprofen, 10%-18%). Conclusions This comprehensive screen of associations between urine drug metabolite levels and self-reported medication use supports the use of pharmacometabolomics to assess medication adherence and prescription patterns in persons with CKD, and indicates underreported use of medications available over the counter, such as analgesics.

MO492SELF-REPORTED MEDICATION USE AND URINARY DRUG METABOLITES IN THE GERMAN CHRONIC KIDNEY DISEASE (GCKD) STUDY: A PHARMACOMETABOLOMIC APPROACH

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Fruzsina Kinga Kotsis ◽  
Ulla T Schultheiß ◽  
Matthias Wuttke ◽  
Pascal Schlosser ◽  
Peter Oefner ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Anatomical Therapeutic Chemical ◽  
Medication Use ◽  
Cardiovascular Risk Reduction ◽  
Prescription Patterns ◽  
Drug Metabolites ◽  
Drug Metabolite ◽  
Urine Drug

Abstract Background and Aims Chronic kidney disease (CKD) patients are prone to prescription of multiple medications. Medication adherence is a well-recognized problem in the management of patients with chronic diseases requiring polypharmacy. This study aimed to evaluate the connection between self-reported medication use and urine drug metabolite levels in a large cohort of CKD patients, the GCKD study, as a basis for future pharmacometabolomics studies. Method Self-reported medication use of 160 substances and 41 medication groups was ascertained at study baseline and coded according to the Anatomical Therapeutic Chemical classification system. A non-targeted mass spectrometry-based approach (Metabolon HD4™) was used for concomitant metabolite quantification in urine. Specificity, sensitivity and accuracy of medication use and the corresponding urine metabolite measurements were calculated. Multivariable regression models (adjusted to age, sex, eGFR, log(UACR), systolic blood pressure, LDL, log(triglycerides), log(HBA1c) were used to establish associations in prescription patterns. Results Among 4,885 participants, 78 drug metabolites were detected in urine (frequency range: 0.4-58%) and assigned into 110 medication – drug metabolite pairs (MMPs) based on reported individual substances and medication groups. For all 68 MMPs of individual substances, accuracy of medication use and the corresponding drug metabolite measurement was excellent (median 97.0%, range 43%-100%), as was measurement-based specificity (median 99.3%, range 73.3%-100%; Fig. 1). Median measurement-based sensitivity was 72.1% (range 1.1%-100%, Fig. 1). Sensitivity and specificity were especially high for angiotensin-II receptor blockers (92%-96%; 99-100%), calcium channel blockers (85-100%; 91-100%), and metoprolol (90%; 98% respectively) commonly prescribed and important medications for blood pressure control and cardiovascular risk reduction in CKD patients. MMPs showing sensitivity &lt;80% included several substances found in over-the-counter (OTC) analgesic medications, suggesting that their use is not always reported. While self-reported use of the OTC analgesics acetaminophen and ibuprofen was &lt;3% each, their corresponding drug metabolites indicated higher usage (acetaminophen: 10-26%; ibuprofen: 10-18%, depending on the number of evaluated drug metabolites). Typical examples of medication co-prescriptions (e.g., trimethoprim and sulfamethoxazole) were detected as the combined presence of their drug metabolites in urine. This result validates the abstraction of single substances from combination medications and this urine-based metabolomic approach. Conclusion This study provides a comprehensive screen of the associations between urine drug metabolite levels and self-reported medication use. It supports the usefulness of pharmacometabolomics to assess medication use, frequency of OTC analgesics use, and prescription patterns in persons with CKD.

scholarly journals Pharmacist-Led Collaborative Medication Management for the Elderly with Chronic Kidney Disease and Polypharmacy

2021 ◽  
Vol 18 (8) ◽  
pp. 4370
Author(s):  
A Kim ◽  
Hayeon Lee ◽  
Eun-Jeong Shin ◽  
Eun-Jung Cho ◽  
Yoon-Sook Cho ◽  
...  
Keyword(s):  
Older Adults ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Medication Management ◽  
Medication Use ◽  
Potentially Inappropriate Medications ◽  
Management Service ◽  
Ckd Stage ◽  
The Impact

Inappropriate polypharmacy is likely in older adults with chronic kidney disease (CKD) owing to the considerable burden of comorbidities. We aimed to describe the impact of pharmacist-led geriatric medication management service (MMS) on the quality of medication use. This retrospective descriptive study included 95 patients who received geriatric MMS in an ambulatory care clinic in a single tertiary-care teaching hospital from May 2019 to December 2019. The average age of the patients was 74.9 ± 7.3 years; 40% of them had CKD Stage 4 or 5. Medication use quality was assessed in 87 patients. After providing MMS, the total number of medications and potentially inappropriate medications (PIMs) decreased from 13.5 ± 4.3 to 10.9 ± 3.8 and 1.6 ± 1.4 to 1.0 ± 1.2 (both p < 0.001), respectively. Furthermore, the number of patients who received three or more central nervous system-active drugs and strong anticholinergic drugs decreased. Among the 354 drug-related problems identified, “missing patient documentation” was the most common, followed by “adverse effect” and “drug not indicated.” The most frequent intervention was “therapy stopped”. In conclusion, polypharmacy and PIMs were prevalent in older adults with CKD; pharmacist-led geriatric MMS improved the quality of medication use in this population.

FC 070USE OF POTENTIALLY NEPHROTOXIC MEDICATIONS IN PERSONS WITH CHRONIC KIDNEY DISEASE: PARALLEL COHORT STUDIES IN SWEDISH AND U.S ROUTINE CARE

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Alessandro Bosi ◽  
Juan Jesus Carrero ◽  
Jung-Im Shin ◽  
Yunwen Xu ◽  
Morgan Grams ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Adverse Drug Events ◽  
Medication Use ◽  
Kidney Injury ◽  
Routine Care ◽  
Clinical Predictors ◽  
Nephrotoxic Drugs ◽  
Study Inclusion ◽  
Swedish Cohort

Abstract Background and Aims Many adverse drug events are preventable, such as those potentially resulting from the prescription of nephrotoxic drugs to persons with chronic kidney disease (CKD). We here quantify the extent of contemporary nephrotoxic medication use in patients with CKD. Method In two observational cohorts of Swedish (Stockholm CREAtinine Measurements [SCREAM] project, Stockholm, Sweden) and U.S. (Geisinger Health System, Pennsylvania) adults with confirmed CKD stages G3-G5 undergoing routine care during 2016-2018, we explored the prescription (in U.S.) and dispensation (in Sweden) of 115 different ambulatory drugs with proven or purported nephrotoxicity during the 12 months following study inclusion. We evaluated the proportion of participants receiving nephrotoxic drugs, ranked main contributors and identified clinical predictors. Results In the Swedish cohort, there were 57880 patients (54.6% women) with median age of 80.00 (inter-quartile range [IQR]: 73.0-86.0) years and eGFR 48.9 ([IQR]: 39.9-55.0) mL/min/1.73 m2. In the U.S. cohort, there were 16255 patients (59% women) with median age of 76 years and eGFR 44 mL/min/1.73 m2. During observation, 20% (Sweden) and 17% (U.S.) of patients received at least one nephrotoxic drug. The top 3 potentially inappropriate nephrotoxic drugs identified were NSAIDs (9% and 11% of participants in U.S. and Sweden received it), antivirals (2.0% and 2.5%) and immunosuppressants (1.5% and 2.7%). Bisphosphonate use was common in Sweden (3.3% of participants), but not in U.S. (0.5%). Conversely, fenofibrates were common in U.S. (3.6%), but not in Sweden (0.13%). In adjusted analyses, patients with young age (&lt;65 years old), women, or with CKD G3 were at higher risk of receiving nephrotoxic medications in both cohorts (P&gt;0.05 for all). Notably, patients aware of their CKD (identified either by issued diagnosis or recent visit to a nephrologist), were at lower risk of nephrotoxic drug use (OR 0.87, 95% CI 0.82-0.92 in Sweden and 0.89, 95% CI 0.81-1.01 in U.S.). Conclusion In two geographically distinct health systems, one in five patients with CKD received potentially inappropriate nephrotoxic medications, mainly NSAIDs. Strategies to increase CKD awareness and physician’s knowledge of drug nephrotoxicity may reduce inappropriate ambulatory prescriptions and prevent iatrogenic kidney injury.

scholarly journals Patterns of medication use and the burden of polypharmacy in patients with chronic kidney disease: the German Chronic Kidney Disease study

2019 ◽  
Vol 12 (5) ◽  
pp. 663-672 ◽  
Author(s):  
Insa M Schmidt ◽  
Silvia Hübner ◽  
Jennifer Nadal ◽  
Stephanie Titze ◽  
Matthias Schmid ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Enzyme Inhibitors ◽  
Medication Use ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Median Number ◽  
Converting Enzyme Inhibitors ◽  
Ckd Stage ◽  
Multiple Drugs

Abstract Background Patients with chronic kidney disease (CKD) bear a substantial burden of comorbidities leading to the prescription of multiple drugs and a risk of polypharmacy. However, data on medication use in this population are scarce. Methods A total of 5217 adults with an estimated glomerular filtration rate (eGFR) between 30 and 60 mL/min/1.73 m2 or an eGFR ≥60 mL/min/1.73m2 and overt proteinuria (>500 mg/day) were studied. Self-reported data on current medication use were assessed at baseline (2010–12) and after 4 years of follow-up (FU). Prevalence and risk factors associated with polypharmacy (defined as the regular use of five or more drugs per day) as well as initiation or termination of polypharmacy were evaluated using multivariable logistic regression. Results The prevalence of polypharmacy at baseline and FU was almost 80%, ranging from 62% in patients with CKD Stage G1 to 86% in those with CKD Stage G3b. The median number of different medications taken per day was eight (range 0–27). β-blockers, angiotensin-converting enzyme inhibitors and statins were most frequently used. Increasing CKD G stage, age and body mass index, diabetes mellitus, cardiovascular disease and a history of smoking were significantly associated with both the prevalence of polypharmacy and its maintenance during FU. Diabetes mellitus was also significantly associated with the initiation of polypharmacy [odds ratio (OR) 2.46, (95% confidence interval 1.36–4.45); P = 0.003]. Conclusion Medication burden in CKD patients is high. Further research appears warranted to address the implications of polypharmacy, risks of drug interactions and strategies for risk reduction in this vulnerable patient population.

scholarly journals Considerable international variation exists in blood pressure control and antihypertensive prescription patterns in chronic kidney disease

2019 ◽  
Vol 96 (4) ◽  
pp. 983-994 ◽  
Author(s):  
Natalia Alencar de Pinho ◽  
Adeera Levin ◽  
Masafumi Fukagawa ◽  
Wendy E. Hoy ◽  
Roberto Pecoits-Filho ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Blood Pressure Control ◽  
Pressure Control ◽  
International Variation ◽  
Prescription Patterns

Integrated Care of Anemia in Chronic Kidney Disease Patients: Concepts in Intravenous Iron Management: Part Two

2010 ◽  
Vol 45 (4) ◽  
pp. 304-313
Author(s):  
Indu Lew ◽  
Tamira Mullarkey ◽  
Robert T. Adamson ◽  
Maria E. Ashton ◽  
Shilpa Amara
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Patient Outcomes ◽  
Medication Use ◽  
The United States ◽  
Cost Of Care ◽  
Iron Therapy ◽  
Deficiency Anemia ◽  
Iv Iron ◽  
Improve Patient

Iron deficiency anemia (IDA), as a result of chronic kidney disease (CKD), has become a worldwide public health issue with increasing prevalence in the United States. An awareness of clinical practice guidelines and safety profiles of intravenous (IV) iron products enables health care professionals to improve patient outcomes in the treatment of CKD-associated IDA. Selection of appropriate IV iron therapy in all patient care settings may encompass considerations such as product premedication and test-dose requirements, preparation and administration, monitoring parameters, safety concerns, cost of care, patient education, and patient self-administration when appropriate. More specifically, a medication use process (prescribing, preparing, dispensing, administering, monitoring, and specific outcomes) should be applied by health systems during the evaluation process to achieve optimal patient outcomes. This performance improvement process serves to promote appropriate medication therapy, improve patient safety, control costs of therapy, stimulate improvements in processes, and provide educational opportunities. This article, the second of a two-part series, describes elements of the medication use process for care of CKD patients with IDA, whereas the preceding article in this series discusses the optimization of IV iron therapy in CKD patients and compares the four parenteral iron agents available on the market.

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