Clinical Pharmacology, Pharmacy and Environmental Medicine, Department of Public Health, University of Southern Denmark, Odense, Denmark.
The Capital Region Pharmacy, Herlev, Denmark.
Basic Clin Pharmacol Toxicol. 2024 Apr;134(4):439-459. doi: 10.1111/bcpt.13986. Epub 2024 Feb 13.
The prevalence of patients with chronic kidney disease (CKD) and polypharmacy is increasing and has amplified the importance of examining inappropriate prescribing (IP) in CKD. This review focuses on the latest research regarding the prevalence of IP in CKD and the related adverse clinical effects and explores new interventions against IP.
A literature search was performed using PubMed, EMBASE and the Cochrane Library searching articles published between June 2016 and March 2022.
Twenty-seven studies were included. An IP prevalence of 12.6% to 96% and 0.3% to 66% was reported in hospital and outpatient settings, respectively. In nonhospital settings, the prevalence of IP varied between 3.9% and 60%. IP was associated with higher risk of hospitalisation (HR 1.46, 95% CI 1.17-1.81), higher bleeding rate (HR 2.34, 95% CI 1.32 to 3.37) and higher risk of all-cause mortality (OR 1.07, 95% CI 1.02 to 1.13). Three studies reported the impact of interventions on IP.
This review highlights widespread IP in CKD patients across healthcare settings, with varying prevalence rates. IP is substantially linked to adverse outcomes in patients. While limited interventions show promise, urgent research is needed to develop effective strategies addressing IP and improving CKD patient care.
慢性肾脏病（CKD）患者和多药治疗的患病率不断增加，这使得检查 CKD 中的不适当处方（IP）变得尤为重要。本综述重点关注关于 CKD 中 IP 的患病率以及相关不良临床影响的最新研究，并探讨针对 IP 的新干预措施。
使用 PubMed、EMBASE 和 Cochrane Library 进行文献检索，检索 2016 年 6 月至 2022 年 3 月期间发表的文章。
共纳入 27 项研究。在医院和门诊环境中，IP 的患病率分别为 12.6%至 96%和 0.3%至 66%。在非医院环境中，IP 的患病率在 3.9%至 60%之间变化。IP 与住院风险增加（HR 1.46，95%CI 1.17-1.81）、更高的出血率（HR 2.34，95%CI 1.32-3.37）和全因死亡率增加（OR 1.07，95%CI 1.02-1.13）相关。有三项研究报告了干预措施对 IP 的影响。
本综述强调了在不同医疗保健环境中，CKD 患者中广泛存在的 IP，且患病率不一。IP 与患者的不良结局密切相关。虽然有限的干预措施显示出希望，但迫切需要开展研究以制定有效的策略来解决 IP 问题并改善 CKD 患者的护理。
