The Prevalence of Potentially Inappropriate Medications Among Patients With Diabetic Nephropathy: A Cross-Sectional Study Conducted at a Tertiary Care Hospital

Abstract

Background Diabetic nephropathy is a serious complication of diabetes that significantly increases the risk of chronic kidney disease (CKD) and end-stage renal disease (ESRD). A critical concern in managing patients with diabetic nephropathy is the prevalence of potentially inappropriate medications (PIMs), which can exacerbate kidney dysfunction and lead to adverse health outcomes. PIMs are defined as medications whose risks outweigh their benefits, particularly when safer alternatives are available. The exact prevalence of the potentially inappropriate fraction of this as well as factors associated with the prescription of these medications remains variable. This study seeks to investigate the prevalence of PIMs in a diabetic population with CKD, aiming to identify the factors that contribute to this issue. Methods We conducted a cross-sectional study analyzing clinical and electronic data from patients with diabetic nephropathy who were receiving care in the wards and outpatient clinics of Hamad Medical Corporation. Data were extracted from medical records, encompassing demographic information, comorbidities, prescribed medications, and kidney function, measured as estimated glomerular filtration rate (eGFR). The American Geriatrics Society Beers Criteria was employed to identify PIMs in older adults. Statistical analyses included chi-square tests for categorical variables and logistic regression to identify factors associated with PIM prescriptions. Results Of the 860 patients analyzed, 248 (28.8%) were prescribed at least one PIM. The most commonly prescribed classes of PIMs were sulfonylureas and nonsteroidal anti-inflammatory drugs (NSAIDs). Significant factors associated with PIM prescriptions included older age (OR 1.52, 95% CI 1.21-1.92), lower eGFR (OR 1.67, 95% CI 1.28-2.19), and polypharmacy (OR 1.83, 95% CI 1.42-2.36). Conclusion In this examination of the combined inpatient and outpatient database of patients with diabetic nephropathy, we identified a high prevalence of PIMs, particularly in individuals of older age, those with lower eGFR, and those experiencing polypharmacy. The findings underscore the importance of addressing polypharmacy through targeted therapeutic interventions aimed at reducing the use of PIMs in this population. By implementing such strategies, we can enhance medication safety and improve overall health outcomes for patients with diabetic nephropathy.

Keywords: adverse drug events; chronic kidney disease (ckd); diabetic nephropathy (dn); polypharmacy; potentially inappropriate medications (pims).

Figure 1. Distribution of PIMs (percentage of patients)

PIMs - potentially inappropriate medications

Figure 2. Logistics regression analysis of factors related to PIM.

PIM - potentially inappropriate medication