Abstract: SA-PO437
Medication Discrepancies in Late Stage CKD
Session Information
- CKD: Epidemiology, Outcomes - Non-Cardiovascular - II
November 04, 2017 | Location: Hall H, Morial Convention Center
Abstract Time: 10:00 AM - 10:00 AM
Category: Chronic Kidney Disease (Non-Dialysis)
- 304 CKD: Epidemiology, Outcomes - Non-Cardiovascular
Authors
- Ibrahim, Jamil, Hofstra Northwell Health School of Medicine, Great Neck, New York, United States
- Hazzan, Azzour, Hofstra Northwell Health School of Medicine, Great Neck, New York, United States
- Sakhiya, Vipulbhai, Hofstra Northwell Health School of Medicine, Great Neck, New York, United States
- Zhang, Meng, Northwell Health, Manhasset, New York, United States
- Halinski, Candice, Hofstra Northwell Health School of Medicine, Great Neck, New York, United States
- Fishbane, Steven, Hofstra Northwell Health School of Medicine, Great Neck, New York, United States
Background
Late stage chronic kidney disease (LS-CKD) is defined by glomerular filtration rate (GFR) 0- 30 ml/min in patients not yet on dialysis. It is a period at high risk for medication discrepancies for multiple reasons. In this study we sought to characterize medication discrepancies in LS-CKD.
Methods
We analyzed patients enrolled in Northwell Health’s Healthy Transitions in Late Stage CKD program from its inception in 2011. All patients had eGFR 0-30 ml/min. Medications were reviewed by a nurse care manager at a home visit, at the first program contact with the patient. The patient presented their medication bottles, with careful review for which medications were actually being used and how they were being taken. The patient’s medication usage and practice were compared to the nephrologist’s electronic health record medication list. We defined high risk discrepancies (HRD) as mismatches in dose or frequency or medications not being taken, excluding laxatives, vitamins and herbals.
Results
All 716 patients were reviewed. The mean age was 67.5±16.5 years, 56% were men, 25% were black, 54% were white, 9% were Hispanic, 51% were diabetic, 93% had hypertension. There were 395 (55.1%) patients with medication discrepancies, 3.2±2.8 (range 1-18) per patient. HRD occurred in 285 patients (39.8% of all patients) with a total of 553 HRD. The most common medications for HRD were antibiotics, cardiovascular medications, analgesics and treatments for renal mineral and bone disorder. By univariate analysis, male gender (p=0.02), hypertension (p=0.047) and CHF (p<0.0001) were predictors of HRD. By multivariable logistic regression only CHF remained a significant predictor of HRD, (odds ratio=1.83, 95% CI 1.28 to 2.59, p= 0.0008).
Conclusion
Medication discrepancies are common in LS-CKD. The presence of CHF is a key predictor of high risk discrepancies. Further research should be directed at systems of care to improve medication safety in LS-CKD.
| Effect | Odds Ratio Point Estimates | 95% Confidence Intervals | P Value | |
| Age | 1.003 | 0.99 | 1.01 | 0.58 |
| Gender: Male vs Female | 1.3 | 0.95 | 1.77 | 0.09 |
| CHF | 1.825 | 1.28 | 2.59 | 0.0008 |
| Hypertension | 1.768 | 0.91 | 3.41 | 0.09 |
Funding
- Other U.S. Government Support