Inappropriate medications prescribed in some Medicare patients with CKD, study finds
Over a third of patients with chronic kidney disease (CKD) enrolled in a Medicare plan's Medication Therapy Management program in 2018 received a prescription for at least one potentially inappropriate medication.
Patients with chronic kidney disease (CKD) who are enrolled in Medicare's Medication Therapy Management (MTM) program may be frequently prescribed medications that may affect kidney function, according to a new study.
Researchers performed an observational cross-sectional study of patients with stage 3 to 5 CKD who were enrolled in an MTM plan in 2018. The goal of the study was to examine the prevalence of potentially inappropriate medications prescribed to patients with CKD and to determine which patients were most likely to receive such prescriptions and from which categories of prescribers. The study looked at medications used to manage chronic diseases in older adults, including diabetes, hypertension, heart failure, fluid retention, osteoporosis, anxiety, depression, arrhythmia, bipolar disorder, schizophrenia, hyperlipidemia, urinary incontinence, acid reflux, seizure, neuropathy, arthritis, psoriatic arthritis, rheumatoid arthritis, pain, allergies, atrial fibrillation, Parkinson's disease, Alzheimer's disease, and gout. Results were published Jan. 27 by the Journal of General Internal Medicine.
A total of 3,624 patients were included in the study. Most (59%) were women, and the median age was 76 years. Overall, 2,856 patients (79%) had stage 3 CKD, 548 (15%) had stage 4, and 220 (6%) had stage 5. Of these groups, 618, 430, and 151, respectively, had at least one potentially inappropriate medication prescribed. In logistic regression analysis, odds of a potentially inappropriate medication were approximately seven to 14 times higher in patients with stage 4 or 5 CKD versus those with stage 3 CKD (P<0.001). Potentially inappropriate medications were also associated with the number of years that a patient qualified for MTM, female sex, and increased polypharmacy (odds ratios, 1.46 to 1.74 [P≤0.005], 1.25 [P=0.008], and 1.30 to 1.57 [P≤0.01], respectively). Among the 21,093 medications prescribed, 2,879 (13.7%) were considered potentially inappropriate, most (62%) prescribed by primary care physicians. Medications that were most likely to be prescribed inappropriately were spironolactone, canagliflozin, sitagliptin, levetiracetam, alendronate, pregabalin, pravastatin, fenofibrate, metformin, gabapentin, famotidine, celecoxib, naproxen, meloxicam, rosuvastatin, diclofenac, and ibuprofen.
The researchers noted that their data were from only one Medicare insurance plan, that their study was retrospective, and that over-the-counter medications could not be considered, among other limitations. They concluded that among the Medicare patients with CKD in their study who were eligible for an MTM plan, more than a third had been prescribed at least one potentially inappropriate medication. This appeared more likely in those with worsening renal function, those with longer MTM eligibility, women, and those taking many medications. Most potentially inappropriate medications were prescribed by primary care physicians. “Patients over the age of 71 years of age may benefit from a targeted review of medications to assess the presence of [potentially inappropriate prescribed medications] due to decline in renal function,” the authors wrote. They also noted that clinical decision support tools may help reduce inappropriate prescribing in this population.