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Kidney Week

Abstract: FR-PO006

Medication Prescribing Patterns in AKI Patients Undergoing Outpatient Dialysis

Session Information

Category: Acute Kidney Injury

  • 101 AKI: Epidemiology, Risk Factors, and Prevention

Authors

  • Manley, Harold J., Dialysis Clinic Incorporated, Albany, New York, United States
  • Aweh, Gideon N., Dialysis Clinic, Inc., Nashville, Tennessee, United States
  • Weiner, Daniel E., Tufts Medical Center, Boston, Massachusetts, United States
  • Dad, Taimur, Tufts Medical Center, Boston, Massachusetts, United States
  • Thakar, Charuhas V., University of Cincinnati, Cincinnati, Ohio, United States
  • Johnson, Doug, Dialysis Clinic, Inc., Nashville, Tennessee, United States
  • Lacson, Eduardo K., Tufts University School of Medicine, Boston, Massachusetts, United States
Background

Beginning 2017, Medicare patients with acute kidney injury (AKI) could receive outpatient dialysis care. We describe medication prescribing trends as recorded in electronic medical records of a large non-profit dialysis provider.

Methods

A retrospective review of AKI patients treated between 1/1/17 and 12/31/18 with follow-up until 3/31/19 at 187 outpatient dialysis clinics. Medications were classified for home/clinic use and by Medi-Span® categories. Demographics, polypharmacy prevalence (PolyRx; ≥ 10 medications) and medication classes were determined at 1 week and 30 days.

Results

A total of 799 patients were identified, 415 (52%) having continuous AKI treatment at least 30 days. Patients were 65 ±14 years, 52% male, 56% white and 95% had at least 1 medication order. We identified 5,035 medications orders at week 1 and 8,185 medications at 30 days. Number of medications and PolyRx occurrence at end of week 1 and 30 days was 7.8 ± 6.6 (median 5) medications vs. 14.4 ± 8 (median 13) (p<0.05) and 32.3% vs. 68% (p<0.001), respectively. As expected, over time, larger proportion of patients were undergoing management of bone-mineral dysfunction or anemia. There were 71 (0.9%) potentially contraindicated or nephrotoxic medications: 5 metformin; 8 NSAIDs; 5 digoxin; 3 rivaroxaban; 50 aminoglycoside. Changes in top medication classes are shown in table.

Conclusion

Patients with AKI have complex medication regimens, high PolyRx incidence and significant changes over time. Incorporating medication reconciliation processes can flag potential unsafe or nephrotoxic medication, and improve patient safety and improve prospects for recovery in AKI patients.

Medi-Span® Medication ClassAKI patients @ week 1
(n=415)
AKI patients @ 30 days
(n=415)
% PatientsClinic RxHome Rx% PatientsClinic RxHome Rx
HEMATOPOIETIC GROWTH FACTORS44%181 86%3551
IRON32%1181586%3551
VIRAL VACCINES27%111 59%244 
HEPARINS AND HEPARINOID-LIKE AGENTS46%187453%2165
INSULIN22% 9147%5188
PHOSPHATE BINDER AGENTS18% 7343% 178
PROTEINS/PROTEIN26%106141%2885
OIL SOLUBLE VITAMINS18%205337%6788
HMG COA REDUCTASE INHIBITORS21% 8835% 145
CALCIUM CHANNEL BLOCKERS18% 7533%1136
LOOP DIURETICS12% 4833% 135