Abstract: SA-PO887
Proton Pump Inhibitor Use in Ambulatory Care Setting in Patients with CKD: A Patient Safety Project
Session Information
- CKD: Pharmacoepidemiology
November 09, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: CKD (Non-Dialysis)
- 2101 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention
Authors
- Sarker, Bidyut K., University of Cincinnati, Cincinnati, Ohio, United States
- Thakar, Charuhas V., University of Cincinnati, Cincinnati, Ohio, United States
- Leonard, Anthony C., University of Cincinnati, Cincinnati, Ohio, United States
Background
Proton pump inhibitors (PPI) are widely prescribed medications, and recent observational studies suggest that PPI exposure increases the risk of adverse renal outcomes including acute kidney injury (AKI), chronic kidney disease (CKD), and progression to end-stage renal disease (ESRD). Timely cessation of PPI therapy may improve patient safety and health care costs.
Objective:To assess PPI use in the absence of indications, the missed opportunities to deprescribe, and to develop strategies for sustainable quality improvement (QI).
Methods
As a requirement of the clinical QI program during nephrology fellowship training, we performed an audit of records spanning September 1, 2018 to May 31, 2019 in an academic outpatient Nephrology clinic.
We selected patients with estimated glomerular filtration rate (eGFR)<60 ml/min/1.73 m2 and used FDA recommendations and American College of Gastroenterology (ACG) consensus derived guideline for PPI indications.
We counted the total number of outpatient clinic visits that patients attended during the study period. Comparisons between groups were tested using Wilcoxon tests to get two-tailed p-values.
Results
116 consecutive clinic patients with eGFR<60 were audited .99% were Male, 23% Black, mean age was 72(standard deviation/SD 9). Mean eGFR was 39(SD 11) ml/min/1.73 m2 and mean BMI was 31(SD 5.6). 53% of patients were diabetic, 91% were hypertensive and 53% had proteinuria. 38% (44/116) patients were on PPI. Of those on PPI, 68% did not have an indication to be on it.Average duration of PPI prescription was 434(SD 145) days in the indicated group compared to 482 (SD 266) days in the non-indicated group (p=.6).PPI were prescribed by PCPs for 77% of patients, with other providers prescribing for 23%.PPI users averaged 8 outpatient clinic visits during the time audited; for indicated patients the average was 8.3, while for non-indicated patients the average was 7.9 visits, which were considered as missed opportunities for PPI deprescription.
Conclusion
Knowing the adverse outcomes associated with PPI use, 68% CKD patients were on PPI despite lack of a clear indication. There were several subsequent missed opportunities to de-prescribe these non-indicated medications. A concerted multidisciplinary program to de-prescribe PPI in high-risk CKD patients can improve patient safety and outcomes.