Use of Potentially Nephrotoxic Medications by U.S. Adults with Chronic Kidney Disease: NHANES, 2011–2016

Shaheen Kurani, Molly Moore Jeffery, Bjorg Thorsteinsdottir, La Tonya J. Hickson, Erin F. Barreto, Jordan Haag, Rachel Giblon, Nilay D. Shah, Rozalina G. McCoy

Research output: Contribution to journalArticle

Abstract

Background: People with chronic kidney disease (CKD) are at risk for adverse events and/or CKD progression with use of renally eliminated or nephrotoxic medications. Objective: To examine the prevalence of potentially inappropriate medication (PIM) use by U.S. adults by CKD stage and self-reported CKD awareness. Design: Cross-sectional analysis of National Health and Nutrition Examination Surveys, 2011–2016 Participants: Non-pregnant adults with stages 3a (eGFR 45–59 mL/min/1.73 m2), 3b (eGFR 30–44), or 4–5 (eGFR < 30) CKD, stratified as CKD-aware/unaware. Main Measures: PIMs were identified on the basis of KDIGO guidelines, label information, and literature review. We calculated proportions using any and individual PIMs, assessing for differences over CKD awareness within each CKD stage. Analyses were adjusted for age, sex, race/ethnicity, education, comorbidities, and insurance type. Key Results: Adjusted proportions of U.S. adults taking any PIM(s) exceeded 50% for all CKD stages and awareness categories, and were highest among CKD-unaware patients with stages 4–5 CKD: 66.6% (95% CI, 55.5–77.8). Proton pump inhibitors, opioids, metformin, sulfonylureas, and non-steroidal anti-inflammatory drugs (NSAIDs) were all used frequently across CKD stages. NSAIDs were used less frequently when CKD-aware by patients with stage 3a CKD (2.2% [95% CI, − 0.3 to 4.7] vs. 10.7% [95% CI, 7.6 to 13.8]) and stages 4–5 CKD (0.8% [95% CI, − 0.9 to 2.5] vs. 16.5% [95% CI, 4.0 to 29.0]). Metformin was used less frequently when CKD-aware by patients with stage 3b CKD (8.1% [95% CI, 0.3–15.9] vs. 26.5% [95% CI, 17.4–35.7]) and stages 4–5 CKD (none vs. 20.8% [95% CI, 1.8–39.8]). The impact of CKD awareness was statistically significant after correction for multiple comparisons only for NSAIDs in stage 3a CKD. Conclusions: PIMs are frequently used by people with CKD, with some impact of CKD awareness on NSAID and metformin use. This may lead to adverse outcomes or hasten CKD progression, reinforcing the need for improved medication management among people with CKD.

Original languageEnglish (US)
JournalJournal of general internal medicine
DOIs
StateAccepted/In press - Jan 1 2019

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Nutrition Surveys
Chronic Renal Insufficiency
Metformin
Anti-Inflammatory Agents
Pharmaceutical Preparations
Disease Progression

ASJC Scopus subject areas

  • Internal Medicine

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Use of Potentially Nephrotoxic Medications by U.S. Adults with Chronic Kidney Disease : NHANES, 2011–2016. / Kurani, Shaheen; Jeffery, Molly Moore; Thorsteinsdottir, Bjorg; Hickson, La Tonya J.; Barreto, Erin F.; Haag, Jordan; Giblon, Rachel; Shah, Nilay D.; McCoy, Rozalina G.

In: Journal of general internal medicine, 01.01.2019.

Research output: Contribution to journalArticle

@article{55ce3aeedafc4037bb5082baf9bbbaa9,
title = "Use of Potentially Nephrotoxic Medications by U.S. Adults with Chronic Kidney Disease: NHANES, 2011–2016",
abstract = "Background: People with chronic kidney disease (CKD) are at risk for adverse events and/or CKD progression with use of renally eliminated or nephrotoxic medications. Objective: To examine the prevalence of potentially inappropriate medication (PIM) use by U.S. adults by CKD stage and self-reported CKD awareness. Design: Cross-sectional analysis of National Health and Nutrition Examination Surveys, 2011–2016 Participants: Non-pregnant adults with stages 3a (eGFR 45–59 mL/min/1.73 m2), 3b (eGFR 30–44), or 4–5 (eGFR < 30) CKD, stratified as CKD-aware/unaware. Main Measures: PIMs were identified on the basis of KDIGO guidelines, label information, and literature review. We calculated proportions using any and individual PIMs, assessing for differences over CKD awareness within each CKD stage. Analyses were adjusted for age, sex, race/ethnicity, education, comorbidities, and insurance type. Key Results: Adjusted proportions of U.S. adults taking any PIM(s) exceeded 50{\%} for all CKD stages and awareness categories, and were highest among CKD-unaware patients with stages 4–5 CKD: 66.6{\%} (95{\%} CI, 55.5–77.8). Proton pump inhibitors, opioids, metformin, sulfonylureas, and non-steroidal anti-inflammatory drugs (NSAIDs) were all used frequently across CKD stages. NSAIDs were used less frequently when CKD-aware by patients with stage 3a CKD (2.2{\%} [95{\%} CI, − 0.3 to 4.7] vs. 10.7{\%} [95{\%} CI, 7.6 to 13.8]) and stages 4–5 CKD (0.8{\%} [95{\%} CI, − 0.9 to 2.5] vs. 16.5{\%} [95{\%} CI, 4.0 to 29.0]). Metformin was used less frequently when CKD-aware by patients with stage 3b CKD (8.1{\%} [95{\%} CI, 0.3–15.9] vs. 26.5{\%} [95{\%} CI, 17.4–35.7]) and stages 4–5 CKD (none vs. 20.8{\%} [95{\%} CI, 1.8–39.8]). The impact of CKD awareness was statistically significant after correction for multiple comparisons only for NSAIDs in stage 3a CKD. Conclusions: PIMs are frequently used by people with CKD, with some impact of CKD awareness on NSAID and metformin use. This may lead to adverse outcomes or hasten CKD progression, reinforcing the need for improved medication management among people with CKD.",
author = "Shaheen Kurani and Jeffery, {Molly Moore} and Bjorg Thorsteinsdottir and Hickson, {La Tonya J.} and Barreto, {Erin F.} and Jordan Haag and Rachel Giblon and Shah, {Nilay D.} and McCoy, {Rozalina G.}",
year = "2019",
month = "1",
day = "1",
doi = "10.1007/s11606-019-05557-8",
language = "English (US)",
journal = "Journal of General Internal Medicine",
issn = "0884-8734",
publisher = "Springer New York",

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T1 - Use of Potentially Nephrotoxic Medications by U.S. Adults with Chronic Kidney Disease

T2 - NHANES, 2011–2016

AU - Kurani, Shaheen

AU - Jeffery, Molly Moore

AU - Thorsteinsdottir, Bjorg

AU - Hickson, La Tonya J.

AU - Barreto, Erin F.

AU - Haag, Jordan

AU - Giblon, Rachel

AU - Shah, Nilay D.

AU - McCoy, Rozalina G.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: People with chronic kidney disease (CKD) are at risk for adverse events and/or CKD progression with use of renally eliminated or nephrotoxic medications. Objective: To examine the prevalence of potentially inappropriate medication (PIM) use by U.S. adults by CKD stage and self-reported CKD awareness. Design: Cross-sectional analysis of National Health and Nutrition Examination Surveys, 2011–2016 Participants: Non-pregnant adults with stages 3a (eGFR 45–59 mL/min/1.73 m2), 3b (eGFR 30–44), or 4–5 (eGFR < 30) CKD, stratified as CKD-aware/unaware. Main Measures: PIMs were identified on the basis of KDIGO guidelines, label information, and literature review. We calculated proportions using any and individual PIMs, assessing for differences over CKD awareness within each CKD stage. Analyses were adjusted for age, sex, race/ethnicity, education, comorbidities, and insurance type. Key Results: Adjusted proportions of U.S. adults taking any PIM(s) exceeded 50% for all CKD stages and awareness categories, and were highest among CKD-unaware patients with stages 4–5 CKD: 66.6% (95% CI, 55.5–77.8). Proton pump inhibitors, opioids, metformin, sulfonylureas, and non-steroidal anti-inflammatory drugs (NSAIDs) were all used frequently across CKD stages. NSAIDs were used less frequently when CKD-aware by patients with stage 3a CKD (2.2% [95% CI, − 0.3 to 4.7] vs. 10.7% [95% CI, 7.6 to 13.8]) and stages 4–5 CKD (0.8% [95% CI, − 0.9 to 2.5] vs. 16.5% [95% CI, 4.0 to 29.0]). Metformin was used less frequently when CKD-aware by patients with stage 3b CKD (8.1% [95% CI, 0.3–15.9] vs. 26.5% [95% CI, 17.4–35.7]) and stages 4–5 CKD (none vs. 20.8% [95% CI, 1.8–39.8]). The impact of CKD awareness was statistically significant after correction for multiple comparisons only for NSAIDs in stage 3a CKD. Conclusions: PIMs are frequently used by people with CKD, with some impact of CKD awareness on NSAID and metformin use. This may lead to adverse outcomes or hasten CKD progression, reinforcing the need for improved medication management among people with CKD.

AB - Background: People with chronic kidney disease (CKD) are at risk for adverse events and/or CKD progression with use of renally eliminated or nephrotoxic medications. Objective: To examine the prevalence of potentially inappropriate medication (PIM) use by U.S. adults by CKD stage and self-reported CKD awareness. Design: Cross-sectional analysis of National Health and Nutrition Examination Surveys, 2011–2016 Participants: Non-pregnant adults with stages 3a (eGFR 45–59 mL/min/1.73 m2), 3b (eGFR 30–44), or 4–5 (eGFR < 30) CKD, stratified as CKD-aware/unaware. Main Measures: PIMs were identified on the basis of KDIGO guidelines, label information, and literature review. We calculated proportions using any and individual PIMs, assessing for differences over CKD awareness within each CKD stage. Analyses were adjusted for age, sex, race/ethnicity, education, comorbidities, and insurance type. Key Results: Adjusted proportions of U.S. adults taking any PIM(s) exceeded 50% for all CKD stages and awareness categories, and were highest among CKD-unaware patients with stages 4–5 CKD: 66.6% (95% CI, 55.5–77.8). Proton pump inhibitors, opioids, metformin, sulfonylureas, and non-steroidal anti-inflammatory drugs (NSAIDs) were all used frequently across CKD stages. NSAIDs were used less frequently when CKD-aware by patients with stage 3a CKD (2.2% [95% CI, − 0.3 to 4.7] vs. 10.7% [95% CI, 7.6 to 13.8]) and stages 4–5 CKD (0.8% [95% CI, − 0.9 to 2.5] vs. 16.5% [95% CI, 4.0 to 29.0]). Metformin was used less frequently when CKD-aware by patients with stage 3b CKD (8.1% [95% CI, 0.3–15.9] vs. 26.5% [95% CI, 17.4–35.7]) and stages 4–5 CKD (none vs. 20.8% [95% CI, 1.8–39.8]). The impact of CKD awareness was statistically significant after correction for multiple comparisons only for NSAIDs in stage 3a CKD. Conclusions: PIMs are frequently used by people with CKD, with some impact of CKD awareness on NSAID and metformin use. This may lead to adverse outcomes or hasten CKD progression, reinforcing the need for improved medication management among people with CKD.

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