Open AccessInappropriate prescribing in chronic kidney disease: A systematic review of prevalence, associated clinical outcomes and impact of interventions
Author(s) -
Tesfaye Wubshet Hailu,
Castelino Ronald L.,
Wimmer Barbara C.,
Zaidi Syed Tabish R.
Publication year - 2017
Publication title -
international journal of clinical practice
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.756
H-Index - 98
eISSN - 1742-1241
pISSN - 1368-5031
DOI - 10.1111/ijcp.12960
Subject(s) - medicine , polypharmacy , cinahl , psychological intervention , medline , kidney disease , cochrane library , systematic review , intensive care medicine , meta analysis , psychiatry , political science , law
Summary Introduction Adjusting doses of renally cleared medications and/or avoidance of nephrotoxic medications are standard clinical practices in chronic kidney disease ( CKD ), albeit the prevalence of inappropriate prescribing ( IP ) in these patients remains high. Therefore, this work sought to systematically review the prevalence of IP and compare the relative effectiveness of available interventions in reducing IP in CKD . Methods Studies were identified searching PubMed/Medline, EMBASE , Cochrane Library, IPA , Web of Science, Ovid/Medline, CINAHL , and Psych INFO databases. Studies defining CKD based on laboratory markers and quantifying prevalence of IP were included. Results Forty‐nine studies from 23 countries met the inclusion criteria. An IP prevalence of 9.4%‐81.1% and 13%‐80.50% was reported in hospital and ambulatory settings, respectively; whereas, in long‐term care facilities the prevalence ranged between 16% and 37.9%. Unsurprisingly, IP was associated with adverse drug events like increased hospital stay (Mean [ SD ] of 4.5 [4.8] vs 4.3 [4.5]) and high risk of mortality [40%]. Twenty‐one studies reported the impact of interventions on IP ; manual and computerised alerts were the main forms of interventions (n=19). The most significant reduction in IP was observed when physicians received immediate concurrent feedback from a clinical pharmacist ( P< .001). Polypharmacy, comorbidities, and age were identified as predictors of IP . Conclusion IP has led to poor patient outcomes. Although pharmacist‐based and computer‐aided approaches have shown promising results, there is still room for improvement. Future studies should focus on developing a multifaceted intervention to address the widespread prevalence of IP and associated clinical outcomes in CKD patients.