Table 3.
Prevalence of kidney-based potentially inappropriate medication use by chronic kidney disease stage
| Potentially inappropriate medication | Chronic kidney disease stage: eGFR
|
Reference | Criteria | Overall use | PIM use | |||
|---|---|---|---|---|---|---|---|---|
| G1: ≥90 | G2: 60–89 | G3a/b: 30–59 | G4/5: <30 | |||||
|
| ||||||||
| Metabolic agents | ||||||||
| Diabetes medication | ||||||||
| Metformin | 99 (17.3%) | 437 (11.0%) | 175 (10.0%) | 4 (4.0%) | Micromedex STOPP |
eGFR <45 mL/min/1.73m2 eGFR <30 mL/min/1.73m2 |
715 (11.2%) | 42 4 |
| Sitagliptin-metformin | 3 (0.5%) | 10 (0.3%) | 2 (0.1%) | 0 | Micromedex | eGFR <45 mL/min/1.73m2 | 15 (0.2%) | 0 |
| Glipizide-metformin | 0 | 5 (0.1%) | 3 (0.2%) | 0 | Micromedex | eGFR <45 mL/min/1.73m2 | 8 (0.1%) | 2 |
| Pioglitazone-metformin | 0 | 6 (0.2%) | 6 (0.3%) | 0 | Micromedex | eGFR <45 mL/min/1.73m2 | 12 (0.2%) | 1 |
| Acarbose | 2 (0.4%) | 0 | 0 | 1 (1.0%) | Micromedex | SCr >2.0 mg/dL | 3 (0.1%) | 1 |
| Exenatide | 1 (0.2%) | 2 (0.1%) | 0 | 0 | Micromedex | CrCl <30 mL/min | 3 (0.1%) | 0 |
| Antihyperlipidemic | ||||||||
| Fenofibrate | 5 (0.9%) | 58 (1.5%) | 73 (4.2%) | 6 (5.9%) | Micromedex | Severe renal impairment | 142 (2.2%) | 6 |
| Gemfibrozil | 4 (0.7%) | 44 (1.1%) | 31 (1.8%) | 1 (1.0%) | Micromedex | Severe renal impairment | 80 (1.3%) | 1 |
| Endocrine-metabolic | ||||||||
| Desmopressin | 0 | 1 (0.0%) | 0 | 0 | Micromedex | CrCl <50 mL/min | 1 (0.0%) | 0 |
| Cardiovascular agents Diuretic (loop and thiazide) | ||||||||
| Triamterene-hydrochlorothiazide | 13 (2.3%) | 162 (4.1%) | 127 (7.2%) | 3 (3.0%) | Micromedex | Significant renal impairment | 305 (4.8%) | 3 |
| Lisinopril-hydrochlorothiazide | 44 (7.7%) | 197 (5.0%) | 106 (6.0%) | 1 (1.0%) | Micromedex | eGFR <30 mL/min/1.73m2 | 348 (5.4%) | 1 |
| Amiloride | 0 | 1 (0.0%) | 0 | 0 | Micromedex Beers |
CrCl <50 mL/min CrCl <30 mL/min |
1 (0.0%) | 0 0 |
| Triamterene | 0 | 1 (0.0%) | 0 | 0 | Micromedex Beers |
SCr >2.5 mg/dL CrCl <30 mL/min |
1 (0.0%) | 0 0 |
| Chlorthalidone | 2 (0.4%) | 23 (0.6%) | 14 (0.8%) | 0 | Micromedex | SCr >2.5 mg/dL | 39 (0.6%) | 0 |
| Hydrochlorothiazide | 69 (12.0%) | 497 (12.5%) | 249 (14.2%) | 10 (9.9%) | Micromedex | SCr >2.5 mg/dL | 825 (12.9%) | 2 |
| Ethacrynic acid | 0 | 0 | 1 (0.1%) | 0 | Micromedex | GFR <10 mL/min | 1 (0.0%) | 0 |
| Aldosterone receptor antagonist | ||||||||
| Eplerenone | 0 | 3 (0.1%) | 2 (0.1%) | 0 | Micromedex | CrCl <30 mL/min | 5 (0.1%) | 0 |
| Spironolactone | 11 (1.9%) | 60 (1.5%) | 58 (3.3%) | 8 (7.9%) | Micromedex Beers |
GFR <10 mL/min CrCl <30 mL/min |
137 (2.1%) | 0 6 |
| Angiotensin II receptor antagonist | ||||||||
| Aliskiren-valsartan | 0 | 1 (0.0%) | 0 | 0 | Micromedex | GFR <60 mL/min | 1 (0.0%) | 0 |
| Olmesartan-amlodipine-hydrochlorothiazide | 2 (0.4%) | 2 (0.1%) | 1 (0.1%) | 0 | Micromedex | CrCl <30 mL/min | 5 (0.1%) | 0 |
| ACE inhibitor | ||||||||
| Amlodipine-benazepril | 9 (1.6%) | 57 (1.4%) | 29 (1.7%) | 0 | Micromedex | CrCl <30 mL/min | 95 (1.5%) | 0 |
| Antihypertensive | ||||||||
| Aliskiren-hydrochlorothiazide | 0 | 1 (0.0%) | 0 | 0 | Micromedex | CrCl <30 mL/min | 1 (0.0%) | 0 |
| Anti-infective agents Antiretroviral | ||||||||
| Lamivudine-zidovudine | 0 | 1 (0.0%) | 0 | 0 | Micromedex | CrCl <50 mL/min | 1 (0.0%) | 0 |
| Antibiotic | ||||||||
| Nitrofurantoin macrocrystalline | 1 (0.2%) | 13 (0.3%) | 3 (0.2%) | 0 | Micromedex | CrCl <60 mL/min | 17 (0.3%) | 2 |
| Amoxicillin-clarithromycin-lansoprazole | 0 | 1 (0.0%) | 1 (0.1%) | 0 | Micromedex | CrCl <30 mL/min | 2 (0.0%) | 0 |
| Trimethoprim | 0 | 4 (0.1%) | 4 (0.2%) | 1 (1.0%) | Micromedex | CrCl <15mL/min | 9 (0.1%) | 0 |
| Sulfamethoxazole-trimethoprim | 2 (0.4%) | 22 (0.6%) | 21 (1.2%) | 2 (2.0%) | Micromedex | CrCl <15mL/min | 47 (0.7%) | 0 |
| Miscellaneous | ||||||||
| Methenamine hippurate | 0 | 2 (0.1%) | 0 | 0 | Micromedex | Renal impairment | 2 (0.0%) | 0 |
| Methenamine-sodium salicylate | 2 (0.4%) | 2 (0.1%) | 1 (0.1%) | 0 | Micromedex | Severe renal impairment | 5 (0.1%) | 0 |
| Central nervous system agents | ||||||||
| Analgesic | ||||||||
| Phenazopyridine | 3 (0.5%) | 6 (0.2%) | 3 (0.2%) | 0 | Micromedex | GFR <50 mL/min | 12 (0.2%) | 2 |
| Fentanyl | 3 (0.5%) | 5 (0.1%) | 6 (0.3%) | 0 | Micromedex | Severe renal impairment | 14 (0.2%) | 0 |
| Anticonvulsant | ||||||||
| Gabapentin | 34 (6.0%) | 169 (4.3%) | 113 (6.4%) | 12 (11.9%) | Micromedex | CrCl <30 mL/min | 328 (5.1%) | 7 |
| Acetazolamide | 0 | 3 (0.1%) | 0 | 0 | Micromedex | CrCl <10 mL/min | 3 (0.1%) | 0 |
| Alzheimer’s/dementia | ||||||||
| Galantamine | 0 | 3 (0.1%) | 2 (0.1%) | 0 | Micromedex Micromedex |
CrCl <9 mL/min Many depending on product | 5 (0.1%) | 0 N/A |
| NSAIDs | 402 (70.4%) | 2,799 (70.6%) | 1,237 (70.4%) | 60 (59.4%) | STOPP Beers |
eGFR <50 mL/min/1.73m2 CrCl <30 mL/min | 4,498 (70.4%) | 632 49 |
| NSAIDs (excluding aspirin containing products) | 188 (32.9%) | 1,127 (28.4%) | 417 (23.7%) | 11 (10.9%) | Micromedex STOPP Beers |
Many depending on product eGFR <50 mL/min/1.73m2 CrCl <30 mL/min | 1,743 (27.3%) | N/A 194 8 |
| Antiparkinsonian | ||||||||
| Pramipexole | 2 (0.4%) | 29 (0.7%) | 8 (0.5%) | 1 (1.0%) | Micromedex | CrCl <30 mL/min | 40 (0.6%) | 1 |
| Selegiline | 0 | 0 | 1 (0.1%) | 0 | Micromedex | CrCl <30 mL/min | 1 (0.0%) | 0 |
| Psychotherapeutic agents | ||||||||
| Buspirone | 2 (0.4%) | 20 (0.5%) | 4 (0.2%) | 0 | Micromedex | Severe renal impairment | 26 (0.4%) | 0 |
| Duloxetine | 4 (0.7%) | 35 (0.9%) | 19 (1.1%) | 4 (4.0%) | Micromedex Beers |
CrCl <30 mL/min CrCl <30 mL/min | 62 (1.0%) | 2 2 |
| Antineoplastic agents | ||||||||
| Capecitabine | 0 | 2 (0.05%) | 1 (0.06%) | 0 | Micromedex | CrCl <30 mL/min | 3 (0.05%) | 0 |
| Methotrexate | 9 (1.6%) | 30 (0.8%) | 29 (1.7%) | 1 (1.0%) | Micromedex | CrCl <10 mL/min | 69 (1.1%) | 0 |
| Calcium regulating agents | ||||||||
| Alendronate | 22 (3.9%) | 144 (3.6%) | 59 (3.4%) | 2 (2.0%) | Micromedex | CrCl <35 mL/min | 227 (3.5%) | 9 |
| Ibandronate | 1 (0.2%) | 14 (0.4%) | 6 (0.3%) | 0 | Micromedex | CrCl <30 mL/min | 21 (0.3%) | 0 |
| Risedronate | 3 (0.5%) | 17 (0.4%) | 13 (0.7%) | 0 | Micromedex | CrCl <30 mL/min | 33 (0.5%) | 0 |
| Zoledronic acid | 0 | 4 (0.1%) | 3 (0.2%) | 0 | Micromedex | CrCl <35 mL/min | 7 (0.1%) | 0 |
| Adrenergic blockers | ||||||||
| Silodosin | 1 (0.1%) | 5 (0.1%) | 1 (0.1%) | 0 | Micromedex | CrCl <30 mL/min | 7 (0.1%) | 0 |
| Adrenergic agonist & 2nd generation antihistamine | ||||||||
| Desloratadine-pseudoephedrine | 0 | 1 (0.0%) | 0 | 0 | Micromedex | Renal impairment | 1 (0.0%) | 0 |
| Anticoagulants Factor Xa inhibitors | Micromedex | CrCl <30 mL/min | 0 | |||||
| Fondaparinux | 0 | 0 | 1 (0.1%) | 0 | Beers STOPP |
CrCl <30 mL/min eGFR <15 mL/min/1.73m2 | 1 (0.0%) | 0 0 |
| Direct thrombin inhibitors | ||||||||
| Dabigatran | 2 (0.4%) | 23 (0.6%) | 14 (0.8%) | 0 | Beers STOPP |
CrCl <30 mL/min eGFR <30 mL/min/1.73m2 | 39 (0.6%) | 0 0 |
| Anticholinergic agents | ||||||||
| Tolterodine | 10 (1.7%) | 22 (0.6%) | 14 (0.8%) | 2 (2.0%) | Micromedex | CrCl <10 mL/min | 48 (0.8%) | 0 |
| Hyperuricemia agents | ||||||||
| Probenecid | 1 (0.2%) | 4 (0.1%) | 4 (0.2%) | 0 | Beers | CrCl <30 mL/min | 9 (0.1%) | 0 |
| Colchicine | 6 (1.1%) | 21 (0.5%) | 44 (2.5%) | 5 (5.0%) | STOPP | eGFR <10 mL/min/1.73m2 | 76 (1.2%) | 1 |
| Hemorrheologic agents | ||||||||
| Pentoxifylline | 0 | 3 (0.1%) | 2 (0.1%) | 0 | Micromedex | CrCl <30 mL/min | 5 (0.1%) | 0 |
*
Micromedex does note that below an eGFR of 30 mL/min/1.73m2, the use of metformin is contraindicated, but Micromedex also notes that patients should not be started on metformin if their eGFR is under 45 mL/min/1.73m2, and that if their eGFR falls below 45 mL/min/1.73m2 “risks and benefits of continued use should be considered” (Glucophage; metformin HCl; oral tablet; 2017).
Key: Potentially inappropriate medication (PIM); creatinine clearance (CrCl); estimated glomerular filtration rate (eGFR); glomerular filtration rate (GFR); Serum creatinine (SCr); Nonsteroidal anti-inflammatory drug (NSAID); Criteria column is the kidney function threshold where medication use is to be avoided; Qualitative criteria such as “significant” or “severe” renal impairment were categorized as eGFR <30 mL/min/1.73m2, and “renal impairment” was categorized as <60 mL/min/1.73