AUTHOR=Aucella Filippo , Corsonello Andrea , Soraci Luca , Fabbietti Paolo , Prencipe Michele Antonio , Gatta Giuseppe , Lattanzio Fabrizia , Cortese Livio , Pagnotta Maria Rosaria , Antonelli Incalzi Raffaele , Aucella Filippo , Benevento Roberta , Cabiddu Gianfranca , Calandra Leonardo , Colucci Marco , Coppolino Giuseppe , De Stefano Filippo , Esposito Ciro , Esposito Vittoria , Fuiano Giorgio , Gatta Giuseppe , Grifa Rachele , Guarneri Marco , Leonardis Daniela , Mallamaci Francesca , Mancini Elena , Mandreoli Marcora , Montalbano Katia , Perna Alessandra , Prencipe Michele , Romani Francesca , Ruosi Carolina , Scichilone Laura , Sileno Giuseppe , Antonelli Incalzi Raffaele , Armentaro Giuseppe , Barbagallo Mario , Bellelli Giuseppe , Bo Mario , Bonanzinga Salvatore , Caloiero Ramona , Cavarape Alessandro , Corica Francesco , Corsonello Andrea , Cortese Livio , Cozza Annalisa , Greco Antonio , Lazzari Ilaria , Leonardo Guerrieri Maurizio , Leosco Dario , Marengoni Alessandra , Monzani Fabio , Rosaria Pagnotta Maria , Sciacqua Angela , Soraci Luca , Tibaldi Vittoria , Ungar Andrea TITLE=A focus on CKD reporting and inappropriate prescribing among older patients discharged from geriatric and nephrology units throughout Italy: A nationwide multicenter retrospective cross-sectional study JOURNAL=Frontiers in Pharmacology VOLUME=13 YEAR=2022 URL=https://www.frontiersin.org/journals/pharmacology/articles/10.3389/fphar.2022.996042 DOI=10.3389/fphar.2022.996042 ISSN=1663-9812 ABSTRACT=

Older hospitalized patients with chronic kidney disease (CKD) are part of the geriatric population with a substantial risk of potentially inappropriate medication (PIM) use. The high rates of multimorbidity and polypharmacy, along with the progressive decline of eGFR, contribute to increasing the risk of drug–drug and drug–disease interactions, overdosing, and adverse drug reactions (ADRs). In this multicenter cross-sectional study, we aimed to evaluate the prevalence of CKD under-reporting and PIMs among older patients discharged from acute geriatric and nephrology units throughout Italy. Renal function was determined by estimated glomerular filtration rate (eGFR) through the Berlin Initiative Study (BIS) equation; the prevalence of PIMs was calculated by revising drug prescriptions at discharge according to STOPP criteria, Beers criteria, and summaries of product characteristics (smPCs). A descriptive analysis was performed to compare the clinical and pharmacological characteristics of patients in the two distinct settings; univariate and multivariate logistic regression models were performed to explore factors associated with CKD under-reporting in the discharge report forms and PIM prevalence. Overall, the study population consisted of 2,057 patients, aged 83 (77–89) years, more commonly women, with a median of seven (5–10) drugs prescribed at discharge. CKD under-reporting was present in 50.8% of the study population, with higher rates in geriatric vs. nephrology units (71.1% vs. 10.2%, p < 0.001). 18.5% of the study population was discharged with at least one renally inappropriate medication; factors associated with at least one contraindicated drug at discharge were the number of drugs (PR 1.09, 95% CI 1.14–1.19); atrial fibrillation (PR 1.35, 95% CI 1.01–1.81); diabetes (PR 1.61, 95% CI 1.21–2.13); being hospitalized in nephrology units (PR 1.62, 95% CI 1.14–2.31), CKD stage 3b (PR 2.35, 95% CI 1.34–4.13), and stage 4–5 (PR 14.01, 95% CI 7.36–26.72). Conversely, CKD under-reporting was not associated with the outcome. In summary, CKD under-reporting and inappropriate medication use were common in older patients discharged from hospital; the relatively high number of PIMs in both nephrology and geriatric settings underlines the need to improve appropriate prescribing during hospital stay and to decrease the risk of ADRs and side effects in this highly vulnerable population.