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Abstract: PO2020

Evaluation of Gabapentinoid Dosing and Adverse Events in Patients with Advanced CKD

Session Information

Category: Pharmacology (PharmacoKinetics, -Dynamics, -Genomics)

  • 1800 Pharmacology (PharmacoKinetics, -Dynamics, -Genomics)

Authors

  • Wells, Drew A., Methodist University Hospital, Memphis, Tennessee, United States
  • Washington, Kayla, Methodist University Hospital, Memphis, Tennessee, United States
  • Cave, Brandon, Methodist University Hospital, Memphis, Tennessee, United States
  • Zhu, Rongshun, The University of Tennessee Health Science Center, Memphis, Tennessee, United States
  • Chinthala, Lokesh K., The University of Tennessee Health Science Center, Memphis, Tennessee, United States
  • Hudson, Joanna Q., The University of Tennessee Health Science Center, Memphis, Tennessee, United States
Background

Gabapentinoids (GP, gabapentin and pregabalin) are frequently prescribed in individuals with chronic kidney disease (CKD); however, their exclusive renal elimination warrants dose adjustments to decrease the risk of toxicity. Data to describe prescribing patterns and incidence of adverse events in advanced CKD are limited. This study evaluated prescribing patterns for GPs and whether excessive dosing was associated with increased incidence of gabapentinoid-related adverse events (GRAEs).

Methods

A retrospective analysis of adult patients admitted to the Methodist LeBonheur Healthcare system from January 2014 – October 2020 with CKD stage 4, 5, or end-stage kidney disease (ESKD) receiving GPs prior to admission or during hospitalization for at least two days was conducted. Patients were grouped based on whether the average daily dose prescribed was higher than recommended [inappropriately dosed, (ID)] or as recommended [appropriately dosed (AD)] for CKD stage. The occurrence of GRAEs (altered mental status, respiratory depression, and falls) was compared between groups. Patient characteristics and CKD stage were evaluated to determine any association with GRAEs. Hospital length of stay (LOS) was also evaluated.

Results

The 200 patients included were predominantly female (51%), black (72%), CKD 5/ESKD (84%) with a mean age 61±14 years, and prescribed gabapentin (90%) with 111 (55%) in the AD group and 89 (45%) in the ID group. Baseline characteristics were similar between groups except type 2 diabetes and neuropathy were more common in the ID group. For the primary outcome, there was no statistically significant difference in GRAEs (18% vs. 19%, p=0.84). GRAEs were associated with older age (mean age 65±11 years for GRAE vs. 60±14 years for no GRAE; p<0.001) and seizure history (14% for GRAE vs. 3% for no GRAE, p=0.02), but not with CKD severity. LOS was significantly longer for patients who experienced a GRAE than for those who did not (8.5 vs. 5.3 days; p=0.04).

Conclusion

In patients with advanced CKD, appropriate dosing of gabapentinoids is important to minimize the risk of adverse events, particularly in patients of older age or with a history of seizures. There is a need for prescriber education given the high frequency of inappropriate gabapentinoid dosing in patients with advanced kidney disease.