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Primary Care Prescriptions of Potentially Nephrotoxic Medications in Children with CKD
Claire E Lefebvre1,2, Kristian B Filion2,3,4, Pauline Reynier4
1Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, Canada.
Insights
Children with chronic kidney disease (CKD) receive prescriptions for potentially nephrotoxic medications at significantly higher rates than those without CKD. This highlights a critical area for improving pediatric kidney care and medication safety.
Area of Science:
- Pediatric Nephrology
- Clinical Pharmacy
- Public Health
Background:
- Management of pediatric chronic kidney disease (CKD) necessitates minimizing further kidney injury.
- Avoiding nephrotoxic medications is a key strategy in pediatric CKD care.
- Prescribing practices for these medications in children with CKD are not well understood.
Purpose of the Study:
- To determine the prevalence and rates of potentially nephrotoxic medication prescriptions in children with CKD.
- To compare these rates against a matched cohort of children without CKD.
Main Methods:
- Retrospective, matched, population-based cohort study using UK Clinical Practice Research Datalink (CPRD) data (1997-2017).
- Matched 1018 children with incident CKD to 4072 children without CKD.
- Analyzed prescription rates for specific medication classes, including NSAIDs, ACE inhibitors, and ARBs.
Main Results:
- 26% of children with CKD received at least one potentially nephrotoxic medication, compared to 15% without CKD.
- Prescription rates were substantially higher in children with CKD (71 per 100 person-years) versus those without (8 per 100 person-years).
- The adjusted rate ratio for prescriptions was 4.1 in children with CKD.
Conclusions:
- Potentially nephrotoxic medications are frequently prescribed to children with CKD.
- These findings underscore the need for improved medication stewardship in pediatric CKD.
- Further research should focus on interventions to reduce nephrotoxic medication exposure in this vulnerable population.
Background And Objectives:
Pediatric CKD management focuses on limiting kidney injury, including avoiding nephrotoxic medications. Nephrotoxic medication prescription practices for children with CKD are unknown. Our objective was to determine the prevalence and rates of primary care prescriptions for potentially nephrotoxic medications in children with CKD versus without CKD.
Design, Setting, Participants, & Measurements:
We conducted a retrospective, matched population-based cohort study of patients aged <18 years, registered at a general practice participating in the UK Clinical Practice Research Datalink (CPRD) from 1997 to 2017. Children with a clinical code indicating an incident diagnosis of CKD were matched 1:4 to patients without CKD on CKD diagnosis date, sex, age, CPRD practice, and number of general practitioner visits in the year before cohort entry. We calculated the prevalence and the rate of potentially nephrotoxic medication prescriptions throughout the follow-up period in patients with versus without CKD. Primary analyses included the following medication classes: aminoglycosides, antivirals, nonsteroidal anti-inflammatory drugs, salicylates, proton pump inhibitors, and immunomodulators. Secondary analyses used an expanded nephrotoxicity definition that also included, among others, angiotensin-converting enzyme inhibitors and angiotensin receptor blockers. Adjusted prescription rates were calculated using multivariable binomial regression.
Results:
From 1,535,816 eligible patients, we identified 1018 incident CKD and 4072 non-CKD matches (mean age, 9.8 years [range, 1.1-17.9 years]; 52% male; mean follow-up time, 3.3 years). Overall, 26% of patients with and 15% of patients without CKD were prescribed one or more potentially nephrotoxic medication during follow-up. The overall rate of nephrotoxic medication prescriptions was 71 (95% confidence interval [95% CI], 55 to 93) prescriptions per 100 person-years in patients with CKD and eight (95% CI, 7 to 9) prescriptions per 100 person-years in patients without CKD (adjusted rate ratio, 4.1; 95% CI, 2.7 to 6.1).
Conclusions:
Potentially nephrotoxic medications are prescribed at high rates to children with CKD.
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