Barbieri Maria Antonietta, Rottura Michelangelo, Cicala Giuseppe, Mandraffino Rossella, Marino Sebastiano, Irrera Natasha, Mannucci Carmen, Santoro Domenico, Squadrito Francesco, Arcoraci Vincenzo
Department of Clinical and Experimental Medicine, University of Messina, 98125 Messina, Italy.
General Practitioner, Provincial Health Unit of Messina, 98100 Messina, Italy.
J Clin Med. 2020 May 4;9(5):1346. doi: 10.3390/jcm9051346.
Nephrotoxic drugs prescriptions are often prescribed inappropriately by general practitioners (GPs), increasing the risk of chronic kidney disease (CKD). The aim of this study was to detect inappropriate prescriptions in patients with CKD and to identify their predictive factors. A retrospective study on patients with creatinine values recorded in the period 2014-2016 followed by 10 GPs was performed. The estimated glomerular filtration rate (eGFR) was used to identify CKD patients. The demographic and clinical characteristics and drugs prescriptions were collected. A descriptive analysis was conducted to compare the characteristics and logistic regression models to estimate the predictive factors of inappropriate prescriptions. Of 4098 patients with creatinine values recorded, 21.9% had an eGFR <60 mL/min/1.73m. Further, 56.8% received inappropriate prescriptions, with a significantly lower probability in subjects with at least a nephrologist visit (Adj OR 0.54 (95% CI 0.36-0.81)) and a greater probability in patients treated with more active substances (1.10 (1.08-1.12)), affected by more comorbidities (1.14 (1.06-1.230)), or with serious CKD (G4/G5 21.28 (7.36-61.57)). Nonsteroidal anti-inflammatory drugs (NSAIDs) were the most used contraindicated drugs (48.5%), while acetylsalicylic acid was the most inappropriately prescribed (39.5%). Our results highlight the inappropriate prescriptions for CKD authorized by GPs and underline the need of strategies to improve prescribing patterns.
全科医生（GP）经常不恰当地开具具有肾毒性的药物处方，从而增加了慢性肾脏病（CKD）的患病风险。本研究旨在检测CKD患者中不恰当的处方，并确定其预测因素。对2014年至2016年期间10位全科医生记录的肌酐值患者进行了一项回顾性研究。采用估计肾小球滤过率（eGFR）来识别CKD患者。收集了人口统计学和临床特征以及药物处方信息。进行了描述性分析以比较特征，并采用逻辑回归模型来估计不恰当处方的预测因素。在记录了肌酐值的4098名患者中，21.9%的患者eGFR<60 mL/min/1.73m²。此外，56.8%的患者接受了不恰当的处方，至少看过一次肾病科医生的患者出现不恰当处方的概率显著更低（调整后的比值比为0.54（95%置信区间为0.36 - 0.81）），而使用更多活性物质进行治疗的患者（1.10（1.08 - 1.12））、患有更多合并症的患者（1.14（1.06 - 1.23））或患有严重CKD（G4/G5期，21.28（7.36 - 61.57））出现不恰当处方的概率更高。非甾体类抗炎药（NSAIDs）是使用最多的禁忌药物（48.5%），而乙酰水杨酸是处方最不恰当的药物（39.5%）。我们的研究结果突出了全科医生开具给CKD患者的不恰当处方，并强调了改善处方模式策略的必要性。
