Potentially inappropriate primary care prescribing in people with chronic kidney disease: a cross-sectional analysis of a large population cohort.
Potentially inappropriate primary care prescribing in people with chronic kidney disease: a cross-sectional analysis of a large population cohort.
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DOI：
10.3399/bjgp.2020.0871
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发表时间：
2021-07
期刊：
影响因子：
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通讯作者：
Guthrie B
中科院分区：
文献类型：
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作者：
MacRae C;Mercer S;Guthrie B
对于慢性肾脏疾病（CKD），许多药物应避免或需要调整剂量。以前对可能不适当的处方率的估计是基于有限数量药物的数据，而且主要是在二级保健机构。确定在已知CKD的完整人群中禁忌症和潜在不适当的初级保健处方的患病率。使用实验室数据对CKD患者的完整地理人群的处方模式进行横断面研究。药物是按照英国国家处方集的建议组织的——禁忌症药物：“避免”；潜在高风险（PHR）药物：“尽可能避免”；剂量不适当（DI）药物：“剂量超过推荐的最大剂量”。CKD的定义是肾小球滤过率(eGFR)≤60 ml/min/1.73 m2，持续bbbb3个月。共有28489名CKD患者被纳入分析，其中70.1%为CKD 3a期，22.4%为CKD 3b期，5.9%为CKD 4期，1.5%为CKD 5期。共有3.9%（95%可信区间[CI] = 3.7 ~ 4.1）的CKD 3a-5期患者处方了≥1种禁忌症药物，24.3% (95% CI = 23.8 ~ 24.8)≥1种PHR药物，15.2% (95% CI = 14.8 ~ 15.6)≥1种DI药物。不同CKD分期的禁忌症药物的患病率不同，在CKD 4期最常使用禁忌症药物，患病率为36.0% （95% CI = 33.7 - 38.2）。PHR药物在所有CKD阶段都是常用的处方，从CKD 4期的19.4% （95% CI = 17.6 - 21.3）到CKD 3a期的25.1% （95% CI = 24.5 - 25.7）不等。慢性肾病4期患者最常开DI类药物（26.4%,95% CI = 24.3 ~ 28.6）。潜在的不当处方在CKD的各个阶段都很常见。需要制定和评估干预措施，以提高这一高危人群的处方安全性。
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. To determine the prevalence of contraindicated and potentially inappropriate primary care prescribing in a complete population of people with known CKD. Cross-sectional study of prescribing patterns in a complete geographical population of people with CKD, defined using laboratory data. 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 m2 for >3 months. 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, and 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, with a prevalence of 36.0% (95% CI = 33.7 to 38.2). PHR 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). 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.