Medication Use, Renin-angiotensin System Inhibitors, and Acute Care Utilization After Hospitalization in Patients with Chronic Kidney Disease

Overview

Journal J Renin Angiotensin Aldosterone Syst

Publisher Sage Publications

Specialty Physiology

Date 2020 Aug 9

PMID 32762427

Citations 1

Authors

Joshua J Neumiller

Kenn B Daratha

Radica Z Alicic

Robert A Short

Haleigh M Miller

Liza Gregg

Brian J Gates

Cynthia F Corbett

Sterling M McPherson

Katherine R Tuttle

Affiliations

Soon will be listed here.

Abstract

Objectives: The aims of this secondary analysis were to: (a) characterize medication use following hospital discharge for patients with chronic kidney disease (CKD), and (b) investigate relationships of medication use with the primary composite outcome of acute care utilization 90 days after hospitalization.

Methods: The CKD-Medication Intervention Trial (CKD-MIT) enrolled acutely ill hospitalized patients with CKD stages 3-5 not dialyzed (CKD 3-5 ND). In this post hoc analysis, data for medication use were characterized, and the relationship of medication use with the primary outcome was evaluated using Cox proportional hazards models.

Results: Participants were taking a mean of 12.6 (standard deviation=5.1) medications, including medications from a wide variety of medication classes. Nearly half of study participants were taking angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARB). ACE inhibitor/ARB use was associated with decreased risk of the primary outcome (hazard ratio=0.51; 95% confidence interval 0.28-0.95; =0.03) after adjustment for baseline estimated glomerular filtration rate, age, sex, race, blood pressure, albuminuria, and potential nephrotoxin use.

Conclusions: A large number, variety, and complexity of medications were used by hospitalized patients with CKD 3-5 ND. ACE inhibitor or ARB use at hospital discharge was associated with a decreased risk of 90-day acute care utilization.

Citing Articles

Kidney organoids reveal redundancy in viral entry pathways during ACE2-dependent SARS-CoV-2 infection.

Vanslambrouck J, Neil J, Rudraraju R, Mah S, Tan K, Groenewegen E J Virol. 2024; 98(3):e0180223.

PMID: 38334329 PMC: 10949421. DOI: 10.1128/jvi.01802-23.

References

Tuttle K, Alicic R, Short R, Neumiller J, Gates B, Daratha K . Medication Therapy Management after Hospitalization in CKD: A Randomized Clinical Trial. Clin J Am Soc Nephrol. 2018; 13(2):231-241. PMC: 5967429. DOI: 10.2215/CJN.06790617. View

Barbosa-Leiker C, McPherson S, Daratha K, Alicic R, Short R, Dieter B . Association Between Prescription Opioid Use and Biomarkers of Kidney Disease in US Adults. Kidney Blood Press Res. 2016; 41(4):365-73. DOI: 10.1159/000443436. View

Go A, Chertow G, Fan D, McCulloch C, Hsu C . Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med. 2004; 351(13):1296-305. DOI: 10.1056/NEJMoa041031. View

Fox C, Muntner P, Chen A, Alexander K, Roe M, Cannon C . Use of evidence-based therapies in short-term outcomes of ST-segment elevation myocardial infarction and non-ST-segment elevation myocardial infarction in patients with chronic kidney disease: a report from the National Cardiovascular Data Acute.... Circulation. 2010; 121(3):357-65. PMC: 2874063. DOI: 10.1161/CIRCULATIONAHA.109.865352. View

Schoolwerth A, Sica D, Ballermann B, Wilcox C . Renal considerations in angiotensin converting enzyme inhibitor therapy: a statement for healthcare professionals from the Council on the Kidney in Cardiovascular Disease and the Council for High Blood Pressure Research of the American Heart.... Circulation. 2001; 104(16):1985-91. DOI: 10.1161/hc4101.096153. View

Nagar V, Birthi P . Chronic opioid pain management for chronic kidney disease. J Pain Palliat Care Pharmacother. 2015; 29(1):48-50. DOI: 10.3109/15360288.2014.997850. View

Alicic R, Short R, Corbett C, Neumiller J, Gates B, Daratha K . Medication Intervention for Chronic Kidney Disease Patients Transitioning from Hospital to Home: Study Design and Baseline Characteristics. Am J Nephrol. 2016; 44(2):122-9. PMC: 5155637. DOI: 10.1159/000447019. View

Hassan Y, Al-Ramahi R, Aziz N, Ghazali R . Adverse drug events in hospitalized patients with chronic kidney disease. Int J Clin Pharmacol Ther. 2010; 48(9):571-6. DOI: 10.5414/cpp48571. View

Bailie G, Eisele G, Liu L, Roys E, Kiser M, Finkelstein F . Patterns of medication use in the RRI-CKD study: focus on medications with cardiovascular effects. Nephrol Dial Transplant. 2005; 20(6):1110-5. DOI: 10.1093/ndt/gfh771. View

10.

White D . Appropriate Use of Opioids in Patients with Kidney Diseases. Clin J Am Soc Nephrol. 2018; 13(5):675-676. PMC: 5968889. DOI: 10.2215/CJN.03540318. View

11.

Patel C, Zimmerman K, Fonda J, Linsky A . Medication Complexity, Medication Number, and Their Relationships to Medication Discrepancies. Ann Pharmacother. 2016; 50(7):534-40. DOI: 10.1177/1060028016647067. View

12.

Tesfaye W, Peterson G, Castelino R, McKercher C, Jose M, Zaidi S . Medication-Related Factors and Hospital Readmission in Older Adults with Chronic Kidney Disease. J Clin Med. 2019; 8(3). PMC: 6462973. DOI: 10.3390/jcm8030395. View

13.

George J, Phun Y, Bailey M, Kong D, Stewart K . Development and validation of the medication regimen complexity index. Ann Pharmacother. 2004; 38(9):1369-76. DOI: 10.1345/aph.1D479. View

14.

Fraser S, Roderick P, May C, McIntyre N, McIntyre C, Fluck R . The burden of comorbidity in people with chronic kidney disease stage 3: a cohort study. BMC Nephrol. 2015; 16:193. PMC: 4666158. DOI: 10.1186/s12882-015-0189-z. View

15.

Brar S, Ye F, James M, Hemmelgarn B, Klarenbach S, Pannu N . Association of Angiotensin-Converting Enzyme Inhibitor or Angiotensin Receptor Blocker Use With Outcomes After Acute Kidney Injury. JAMA Intern Med. 2018; 178(12):1681-1690. PMC: 6583606. DOI: 10.1001/jamainternmed.2018.4749. View

16.

Daratha K, Short R, Corbett C, Ring M, Alicic R, Choka R . Risks of subsequent hospitalization and death in patients with kidney disease. Clin J Am Soc Nephrol. 2012; 7(3):409-16. DOI: 10.2215/CJN.05070511. View

17.

Colavecchia A, Putney D, Johnson M, Aparasu R . Discharge medication complexity and 30-day heart failure readmissions. Res Social Adm Pharm. 2016; 13(4):857-863. DOI: 10.1016/j.sapharm.2016.10.002. View

18.

Manley H, Garvin C, Drayer D, Reid G, Bender W, Neufeld T . Medication prescribing patterns in ambulatory haemodialysis patients: comparisons of USRDS to a large not-for-profit dialysis provider. Nephrol Dial Transplant. 2004; 19(7):1842-8. DOI: 10.1093/ndt/gfh280. View

19.

Al-Ramahi R . Medication prescribing patterns among chronic kidney disease patients in a hospital in Malaysia. Saudi J Kidney Dis Transpl. 2012; 23(2):403-8. View

20.

Levin A, Tonelli M, Bonventre J, Coresh J, Donner J, Fogo A . Global kidney health 2017 and beyond: a roadmap for closing gaps in care, research, and policy. Lancet. 2017; 390(10105):1888-1917. DOI: 10.1016/S0140-6736(17)30788-2. View