Potentially inappropriate medications in CKD linked to dim outcomes

Chronic kidney disease (CKD) patients prescribed potentially inappropriate medications (PIMs) risk falling, being hospitalized, and dying, with the greatest risk occurring among those who have more than one PIM prescription, as shown in a study.

The analysis used data from the Chronic Renal Insufficiency Cohort (CRIC) study and included 3,929 adults with CKD. PIM exposure was established as prescriptions for any medications that must be avoided in older adults as defined by the 2015 American Geriatrics Society Beers Criteria.

Outcomes assessed were hospitalization count, death, a composite kidney disease endpoint of CKD progression or initiation of kidney replacement therapy (KRT), KRT, and fall events assessed 1 year after PIM exposure.

Proton pump inhibitors and alpha blockers emerged as the most prescribed PIMs. Compared with none, any PIM exposure contributed to increased risks of hospitalizations, death, and fall events.

In multivariable Poisson and logistic regression models, exposure to 1, 2, or ≥3 PIMs was associated with a graded increase in hospitalization rate (relative risk [RR] 1.09, 95 percent confidence interval [CI] 1.01–1.17; RR 1.18, 95 percent CI 1.07–1.30; and RR 1.35, 95 percent CI, 1.19–1.53, respectively) and a higher likelihood of mortality (odds ratio [OR] 1.19, 95 percent CI 0.91–1.54; OR 1.62, 95 percent CI 1.21–2.17; and OR 1.65, 95 percent CI 1.14–2.41, respectively).

In a subset of patients who experienced fall events (n=1,109), prescriptions for ≥3 PIMs conferred a heightened risk of falls (adjusted OR 2.85, 95 percent CI 1.54–5.26).

Neither CKD progression nor KRT was associated with PIMs. Moreover, age did not alter the association between PIM count and outcomes.

The study was limited by measurement bias and confounding by indication.