Patients with chronic kidney disease (CKD) who take potentially inappropriate medications (PIMs) may increase their risks for falls, hospitalization, and death, a new study finds.
In an analysis of the Chronic Renal Insufficiency Cohort (CRIC) study including 3929 adults aged 21 to 74 years with CKD (approximately 20% with an estimated glomerular filtration rate of less than 30 mL/min/1.73 m2), 80% of patients had a history of taking 1 or more PIMs, Rasheeda Hall, MD, MBA, MHSc, of Duke University in Durham, North Carolina, and colleagues reported in the American Journal of Kidney Diseases. Patients taking 3 or more of these PIMs had significant 2.85-fold increased odds of falling compared with those not taking any PIMs. The risk for any hospitalization was significantly increased by 9%, 18%, and 35%, respectively, for patients taking 1, 2, and 3 or more PIMs, respectively. Patients taking 2 and 3 or more PIMs had significant 62% and 65% increased odds for all-cause mortality risk, respectively. The investigators found no significant associations between medication use and CKD progression. Older patient age and total number of all medications did not explain the results.
Inappropriate medications were defined by the 2015 American Geriatrics Society Beers Criteria. They included proton pump inhibitors, alpha blockers, nonsteroidal anti-inflammatory drugs (NSAIDs), anticholinergics, central alpha agonists, benzodiazepines, antidepressants, muscle relaxants, estrogen, digoxin, and nonbenzodiazepines. The drugs are used for common CKD comorbidities, such as hypertension, benign prostatic hyperplasia, depression, and gastroesophageal reflux disease. Each of these medications may not carry the same risk of harm, the investigators acknowledged. Additional studies are needed to understand the risk attributable to individual medication classes, they discussed. Comorbidities themselves and patient frailty also contribute to risks.
“These findings suggest additional evidence is needed to guide prescribing of [potentially inappropriate medications] in the general adult CKD population regardless of age to both minimize adverse outcomes and optimally manage comorbid conditions,” according to Dr Hall’s team.
Deprescribing these drugs would be challenging, they wrote, so strategies such as reassessing need, discussing risks with patients, and medication tapering might be helpful.
Hall RK, Blumenthal JB, Doerfler RM, et al; CRIC Study Investigators. Risk of potentially inappropriate medications in adults with CKD: findings from the Chronic Renal Insufficiency Cohort (CRIC) study. Am J Kidney Dis. Published online May 21, 2021. doi:10.1053/j.ajkd.2021.03.019