Nephrotoxic medication burden and drug-related problems in patients with chronic kidney disease using SGLT2 inhibitors.
This study found that a significant number of drug-related problems were identified in CKD patients on SGLT2 inhibitors, but no clinically overt nephrotoxic events occurred during the follow-up.
Where it sits
this study against the rest of the epitalon (epithalon) corpusSummary and findings
This observational study evaluated drug-related problems (DRPs) and nephrotoxic medication burden in patients with chronic kidney disease (CKD) prescribed SGLT2 inhibitors. A total of 72 patients were included, with a median of 2 nephrotoxic drugs per patient. No clinically overt nephrotoxic events were observed during follow-up.
Abstract
<h4>Background</h4>Sodium-glucose cotransporter 2 inhibitors (SGLT2i) are increasingly prescribed because of their renal and cardiovascular benefits. However, polypharmacy is common among patients with chronic kidney disease (CKD), raising concerns about cumulative nephrotoxic medication exposure. This study aimed to evaluate drug-related problems (DRPs), nephrotoxic medication burden, kidney failure risk, and patient-reported outcomes in patients receiving SGLT2i in a nephrology outpatient clinic.<h4>Methods</h4>This observational study was conducted in a nephrology outpatient clinic of a university hospital between September 2022-February 2023. Patients ≥18 years who were newly prescribed an SGLT2 inhibitor were included. A clinical pharmacist performed comprehensive medication reviews, identified and categorized DRPs using the Pharmaceutical Care Network Europe (PCNE) classification system, and assessed nephrotoxic exposure by a structured nephrotoxicity score based on drug-specific risk categories. Kidney failure risk was estimated using the Kidney Failure Risk Equation, and quality of life was assessed using the KDQOL-36 questionnaire.<h4>Results</h4>Seventy-two patients were included, and 69 DRPs were identified through clinical pharmacist-led medication review. The most common DRPs were inappropriate duration of therapy (20.3%), medication without indication (15.9%), and untreated symptoms (13.0%). Pharmacist's recommendations were highly accepted (85.5%). The median number of nephrotoxic drugs per patient was 2 (IQR:1-3), while the median nephrotoxicity score was 1.5 (IQR: 1-2). No clinically overt nephrotoxic events were observed during follow-up, and nephrotoxicity burden was not significantly associated with estimated kidney failure risk.<h4>Conclusion</h4>This study provides real-world descriptive data on nephrotoxic medication exposure, drug-related problems, and clinical pharmacist-led medication review among CKD patients receiving SGLT2i in a nephrology outpatient setting. Further prospective controlled studies are needed to clarify the clinical impact of pharmacist-led medication review on patient.
Background
This paper addresses the issue of nephrotoxic medication burden in patients with chronic kidney disease (CKD) who are prescribed sodium-glucose cotransporter 2 inhibitors (SGLT2i). Prior knowledge indicates that polypharmacy is common in this population, raising concerns about cumulative nephrotoxic exposure. Understanding drug-related problems (DRPs) and nephrotoxic risks in this context is crucial for optimizing patient care.
Methods
This observational study was conducted in a nephrology outpatient clinic from September 2022 to February 2023. Patients aged 18 years and older who were newly prescribed an SGLT2 inhibitor were included, with a total sample size of 72. A clinical pharmacist performed comprehensive medication reviews, categorized DRPs using the Pharmaceutical Care Network Europe (PCNE) classification, and assessed nephrotoxic exposure using a structured nephrotoxicity score.
Results
The study identified 69 drug-related problems through clinical pharmacist-led medication review. The most prevalent DRPs were inappropriate duration of therapy (20.3%), medication without indication (15.9%), and untreated symptoms (13.0%). The median nephrotoxicity score was reported as 1.5 (IQR: 1-2), and no clinically overt nephrotoxic events were observed during the follow-up period.
Interpretation
The findings provide descriptive data on nephrotoxic medication exposure and DRPs in CKD patients receiving SGLT2i. While the study highlights a significant number of DRPs, the clinical significance of these findings is uncertain due to the lack of overt nephrotoxic events and the small sample size. The absence of a significant association between nephrotoxicity burden and kidney failure risk suggests that further research is needed to clarify these relationships.
Key findings
- 72 patients included in the study.
- 69 drug-related problems identified, with the most common being inappropriate duration of therapy (20.3%).
- Median number of nephrotoxic drugs per patient was 2 (IQR: 1-3).
- Median nephrotoxicity score was 1.5 (IQR: 1-2).
- Pharmacist's recommendations were accepted in 85.5% of cases.
- No clinically overt nephrotoxic events observed during follow-up.
Limitations
- Observational study design.
- Small sample size (n=72).
- Short follow-up period.
- No long-term data on nephrotoxicity outcomes.
- Single-site study.