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Kidney Week

Abstract: FR-PO1154

Primary Care Prescriptions of Nephrotoxic Medications to Children with CKD

Session Information

  • Pediatric Nephrology - I
    October 26, 2018 | Location: Exhibit Hall, San Diego Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Pediatric Nephrology

  • 1600 Pediatric Nephrology

Authors

  • Lefebvre, Claire, McGill University, Montreal, Quebec, Canada
  • Filion, Kristian B., McGill University, Montreal, Quebec, Canada
  • Reynier, Pauline, Lady davis institute, Montreal, Quebec, Canada
  • Platt, Robert, McGill University, Montreal, Quebec, Canada
  • Zappitelli, Michael, Toronto Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
Background

Nephrotoxic medication (NTM) prescription practices for children with chronic kidney disease (CKD) are unknown. Our objective was to determine if primary care prescriptions of NTMs differ for children with and without CKD.

Methods

We conducted a retrospective, population-based, matched 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, with linkage to Hospital Episode Statistics data. Patients with incident CKD were matched 4:1 to non-CKD patients on CKD diagnosis date, sex, age, CPRD practice, and number of pre-cohort entry physician visits. Prevalence of prescription of NTM was compared between CKD and non-CKD patients, with adjusted prescription rates calculated using multivariable binomial regression.

Results

From our base cohort of 1,535,816 patients, we identified 1018 with incident CKD and 4072 non-CKD matches; mean age: 9.8 years [range: 1.1-17.9]; 52% male; mean follow-up time 3.2 vs. 3.3 years in CKD vs. non-CKD patients. CKD patients had higher prevalences of diabetes, hypertension, heart failure/surgery, and past hospitalizations (p<0.01 for all). A total of 32% CKD patients and 14.6% non-CKD patients were prescribed ≥1 NTM during follow-up (p<0.01). Excluding ACE-inhibitors and salicylates, 25.8% and 14.5% were prescribed ≥1 NTM, respectively. From cohort entry to end of follow-up, the proportion of CKD patients receiving ≥1 NTM remained similar (17.6%-19.5%/year). Adjusted NTM prescription rates in CKD vs. non-CKD patients were 37.0 (95% CI 19.4-70.6) vs. 3.7 (95% CI 2.1-6.6) prescriptions/100 person-years, respectively (rate ratio [RR]: 9.9 (95% CI 7.3-13.4). Excluding ACE inhibitors and salicylates, the adjusted RR was 4.1 (95% CI 2.1-6.6).

Conclusion

NTMs are prescribed at elevated rates to children with CKD. There may be a need for awareness/education interventions aimed at primary care practitioners on potential harm from NTMs on pediatric CKD progression.

Funding

  • Government Support - Non-U.S.