Table 2.
Crude Rates of Potentially Inappropriate Medication (PIM) Use Across a Range of Kidney Function and Chronic Kidney Disease (CKD) Awareness
| No CKD* | Stage 3a | Stage 3a | Stage 3b | Stage 3b | Stages 4–5 | Stages 4–5 | p value† | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Unaware | Aware | Unaware | Aware | Unaware | Aware | ||||||||||
| % | (95% CI) | % | (95% CI) | % | (95% CI) | % | (95% CI) | % | (95% CI) | % | (95% CI) | % | (95% CI) | ||
| None | 76 | (74.7, 77.2) | 46.1 | (40.9, 51.5) | 34.4 | (22.0, 49.3) | 37.5 | (30.5, 45.2) | 31.3 | (20.6, 44.4) | 33.3 | (20.9, 48.5), | 46.1 | (32.2, 60.5) | < 0.001 |
| Any | 24 | (22.8, 25.3) | 53.9 | (48.5, 59.1) | 65.6 | (50.7, 78.0) | 62.5 | (54.8, 69.5) | 68.7 | (55.6, 79.4) | 66.7 | (51.5, 79.1) | 53.9 | (39.5, 67.8) | |
| Nephrotoxic medications | |||||||||||||||
| NSAIDs | 5.3 | (4.7, 5.9) | 10.8 | (7.9, 14.6) | 1.9 | (0.6, 5.9) | 6.4 | (3.4, 11.9) | 6.7 | (2.7, 15.8) | 13.6 | (5.7, 29.0) | 1.0 | (0.1, 7.1) | < 0.001 |
| PPIs | 7.9 | (7.2, 8.6) | 21.0 | (17.3, 25.2) | 26.5 | (15.4, 41.7) | 26.1 | (19.2, 34.4) | 27.3 | (18.3, 38.7) | 20.7 | (11.5, 34.6) | 21.9 | (13.5, 33.7) | < 0.001 |
| Renally cleared medications | |||||||||||||||
| Opioids | 6.1 | (5.3, 7.1) | 9.4 | (6.4, 13.4) | 21.4 | (8.9, 43.1) | 11.5 | (7.2, 17.8) | 13.8 | (6.8, 25.9) | 17.2 | (10.2, 27.4) | 11.8 | (6.2, 21.4) | < 0.001 |
| Metformin | 6.4 | (5.9, 7.1) | 13.8 | (11.4, 16.6) | 19.1 | (9.2, 35.5) | 9.6 | (5.9, 15.2) | 4.0 | (1.6, 9.9) | 9.0 | (3.5, 21.2) | 0 | – | < 0.001 |
| Sulfonylurea | 2.4 | (2.0, 2.8) | 6.5 | (4.7, 8.9) | 8.3 | (4.1, 16.1) | 15.5 | (10.3, 22.5) | 16.5 | (9.3, 27.6) | 14.2 | (5.4, 32.7) | 8.8 | (3.9, 18.6) | < 0.001 |
| Anti-gout | 0.9 | (0.7, 1.0) | 4.3 | (2.5, 7.3) | 11.8 | (5.3, 24.4) | 5.9 | (3.3, 10.1) | 12.7 | (7.2, 21.4) | 3.3 | (0.4, 21.0) | 12.0 | (6.4, 21.5) | < 0.001 |
| Anticoagulants | 0.2 | (0.2, 0.3) | 1.0 | (0.5, 2.1) | 1.9 | (0.4, 8.5) | 4.2 | (1.7, 9.9) | 3.5 | (1.2, 10.3) | 2.7 | (0.4, 17.0) | 0 | – | < 0.001 |
| Anti-seizure | 3.0 | (2.6, 3.4) | 4.9 | (3.5, 6.8) | 7.4 | (3.2, 16.4) | 8.1 | (4.5, 14.2) | 13.4 | (7.2, 23.6) | 17.3 | (8.1, 33.2) | 11.3 | (5.6, 21.6) | < 0.001 |
| Nephrotoxic and renally cleared medications | |||||||||||||||
| Bisphosphonates | 0.7 | (0.6, 0.9) | 2.2 | (1.1, 4.2) | 1.9 | (0.4, 8.4) | 5.5 | (2.9, 10.1) | 4.9 | (1.7, 13.1) | 1.6 | (0.2, 11.6) | 0 | – | < 0.001 |
| Other‡ | 3.5 | (3.1, 3.9) | 13.4 | (10.3, 17.3) | 13.2 | (5.9, 27.0) | 17.3 | (12.0, 24.2) | 14.3 | (7.6, 25.2) | 9.2 | (4.0, 19.7) | 12.1 | (5.7, 23.7) | < 0.001 |
Data are shown as percentage and 95% CI, except as otherwise indicated. All percentages were calculated taking into account complex survey design, with the denominator set to all non-pregnant adults ≥ 20 years with each level of kidney function and CKD awareness. NSAIDs, non-steroidal anti-inflammatory drugs; PPIs, proton pump inhibitors
*People with eGFR ≥ 60 mL/min/1.73 m2 were considered as not having CKD; PIMs do not represent inappropriate use in this group, which serves as a comparison group only
†p value tests for difference in proportions of people taking the specific PIM class across all stages of kidney function and CKD awareness
‡The “other” category of PIMs includes acarbose (renally cleared), amantadine (renally cleared), atenolol (renally cleared), digoxin (renally cleared), fenofibrate (both), fesoterodine (renally cleared), fexofenadine (renally cleared), lithium (both), quinidine (both), quinine (renal toxicity), and tacrolimus (renal toxicity)