Clin Nephrol. 2022 Sep;98(3):147-154. doi: 10.5414/CN110815.
Gabapentinoids (GPs) are frequently prescribed in individuals with chronic kidney disease (CKD); however, their exclusive renal elimination warrants dose adjustments to decrease risk of toxicity. This study evaluated GP prescribing patterns and whether excessive dosing was associated with increased incidence of gabapentinoid-related adverse events (GRAEs).
A retrospective analysis of adult CKD and end-stage kidney disease (ESKD) patients hospitalized from 2014 to 2020 and receiving GPs was conducted. Patients were grouped based on whether the average daily dose prescribed was higher than recommended (inappropriately dosed, (ID)) or as recommended (appropriately dosed (AD)) for CKD stage. The occurrence of GRAEs was compared between groups. Patient characteristics, CKD stage, and hospital length of stay (LOS) were evaluated to determine association with GRAEs.
The 200 patients included were predominantly female (51%), black (72%), CKD 5/ESKD (84%), and prescribed gabapentin (90%) with a mean age 61 ± 14 years. For the 111 (55%) patients in the AD group and 89 (45%) in the ID group there was no statistically significant difference in GRAEs (18 vs. 19%, p = 0.84). GRAEs were associated with older age (66 vs. 61 years; p < 0.001), seizure history (14% for GRAE vs. 3% for no GRAE, p = 0.02), and concomitant antipsychotic use (24% for GRAE vs. 5% for no GRAE; p < 0.001) but not with CKD severity. LOS was significantly longer for patients experiencing a GRAE (8.5 vs. 5.3 days; p < 0.001).
Appropriate dosing of GPs is particularly important to minimize the risk of adverse events in patients of older age, with a history of seizures, or concomitant antipsychotic use. There is a need for prescriber education given the high frequency of inappropriate GP dosing observed in patients with advanced kidney disease.
加巴喷丁类药物（GP）在慢性肾脏病（CKD）患者中经常被开处方；然而，它们的唯一肾脏消除途径需要调整剂量，以降低毒性风险。本研究评估了 GP 的处方模式，以及是否过度给药与加巴喷丁类药物相关不良事件（GRAE）的发生率增加有关。
对 2014 年至 2020 年住院的慢性肾脏病和终末期肾病（ESKD）成年患者进行了回顾性分析，这些患者接受了 GP 治疗。根据处方的平均日剂量是否高于推荐剂量（不适当剂量（ID））或推荐剂量（适当剂量（AD）），将患者分为两组。比较两组之间 GRAE 的发生情况。评估患者特征、CKD 分期和住院时间（LOS），以确定与 GRAE 相关的因素。
纳入的 200 名患者主要为女性（51%）、黑人（72%）、CKD 5/ESKD（84%），并开了加巴喷丁（90%），平均年龄为 61 ± 14 岁。在 AD 组的 111 名（55%）患者和 ID 组的 89 名（45%）患者中，GRAE 的发生率没有统计学差异（18%对 19%，p=0.84）。GRAE 与年龄较大（66 岁对 61 岁；p<0.001）、癫痫病史（GRAE 患者为 14%，无 GRAE 患者为 3%，p=0.02）和同时使用抗精神病药物（GRAE 患者为 24%，无 GRAE 患者为 5%，p<0.001）有关，但与 CKD 严重程度无关。发生 GRAE 的患者的 LOS 明显更长（8.5 天对 5.3 天；p<0.001）。
对于年龄较大、有癫痫病史或同时使用抗精神病药物的患者，适当调整 GP 剂量尤为重要，以降低不良事件的风险。鉴于在晚期肾病患者中观察到 GP 剂量不适当的频率较高，需要对医生进行教育。
