Researchers analyse over 20 years of data of children from general primary care practices in the United Kingdom to demonstrate the prescription of nephrotoxic drugs to children with chronic kidney disease.
In the study, data from 1997 to 2017 on 1,018 children newly diagnosed with chronic kidney disease and 4,072 children with normal kidney function who receive care at general primary care practices in the United Kingdom were analysed. Children with CKD were matched 1:4 with patients without CKD. The researchers labelled medications as Category A (consistently recognized as toxic to the kidneys) and Category B (recognized as potentially toxic to the kidneys).
The analysis included 1,018 patients with newly diagnosed CKD who were matched to 4,072 patients without CKD. Over an average follow-up of 3.3 years, 26 percent of patients with CKD and 15 percent of patients without CKD were prescribed one or more Category A medications. When considering Category B medications (which include Category A medications), 71 percent of patients with CKD and 50% of patients without CKD received at least one medication during follow-up.
The rate of Class A prescriptions was 71 per 100 person-years and 8 per 100 person-years in CKD and non-CKD patients, respectively. (A person-year is the number of years of follow-up multiplied by the number of people in the analysis.) The respective rates of Class B prescriptions were 278 vs. 44 per 100 person-years. Analyses revealed that children with CKD were prescribed medications that were potentially toxic to the kidneys at a rate that was four-times higher than in children without CKD.
“We have shown that medications potentially toxic to the kidney are prescribed at high rates to children with kidney disease, suggesting the need for increased awareness among physicians and patients about this problem,” said Dr. Lefebvre. “We hope this research will encourage future studies evaluating the reasons for these high rates and, eventually, the development of clinical decision support systems and physician education programs to reduce inappropriate nephrotoxic medication prescribing in children with CKD.”
The research team has suggested through their findings more research is needed to determine whether these medications are necessary and appropriate, or if alternatives could be prescribed instead.
The findings were published in December 2019 on the Clinical Journal of American Society of Nephrology. [APBN]