Preventing acute kidney injury in high-risk patients by temporarily discontinuing medication - an observational study in general practice

BMC Nephrol. 2019 Dec 4;20(1):449. doi: 10.1186/s12882-019-1636-z.

Abstract

Background: Elderly, patients with chronic kidney disease (CKD) and patients with heart failure who continue using renin-angiotensin-aldosterone-system (RAAS) inhibitors, diuretics, or non-steroidal-anti-inflammatory drugs (NSAIDs) during times of fluid loss have a high risk of developing complications like acute kidney injury (AKI). The aim of this study was to assess how often advice to discontinue high-risk medication was offered to high-risk patients consulting the general practitioner (GP) with increased fluid loss. Furthermore, we assessed the number and nature of the complications that occurred after GP consultation.

Methods: We performed a cross-sectional study with patients from seven Dutch general practices participating in the Family Medicine Network between 1 and 6-2013 and 1-7-2018. We included patients who used RAAS-inhibitors, diuretics, or NSAIDs, and had at least one of the following risk factors: age ≥ 70 years, CKD, or heart failure. From this population, we selected patients with a 'dehydration-risk' episode (vomiting, diarrhoea, fever, chills, or gastrointestinal infection). We manually checked their electronic patient files and assessed the percentage of episodes in which advice to discontinue the high-risk medication was offered and whether a complication occurred in 3 months after the 'dehydration-risk' episode.

Results: We included 3607 high-risk patients from a total of 44.675 patients (8.1%). We found that patients were advised to discontinue the high-risk medication in 38 (4.6%) of 816 'dehydration-risk' episodes. In 59 of 816 episodes (7.1%) complications (mainly AKI) occurred.

Conclusions: Dutch GPs do not frequently advise high-risk patients to discontinue high-risk medication during 'dehydration-risk' episodes. Complications occur frequently. Timely discontinuation of high-risk medication needs attention.

Keywords: Acute kidney injury; Chronic kidney disease; Dehydration; Deprescribing; General practice.

Publication types

  • Observational Study

MeSH terms

  • Acute Kidney Injury* / etiology
  • Acute Kidney Injury* / prevention & control
  • Aged
  • Angiotensin Receptor Antagonists* / adverse effects
  • Angiotensin Receptor Antagonists* / therapeutic use
  • Angiotensin-Converting Enzyme Inhibitors* / adverse effects
  • Angiotensin-Converting Enzyme Inhibitors* / therapeutic use
  • Anti-Inflammatory Agents, Non-Steroidal* / adverse effects
  • Anti-Inflammatory Agents, Non-Steroidal* / therapeutic use
  • Dehydration* / complications
  • Dehydration* / physiopathology
  • Dehydration* / therapy
  • Deprescriptions*
  • Diuretics* / adverse effects
  • Diuretics* / therapeutic use
  • Female
  • General Practice / methods
  • Heart Failure / drug therapy*
  • Heart Failure / physiopathology
  • Humans
  • Male
  • Renal Insufficiency, Chronic / physiopathology
  • Risk Adjustment / methods*
  • Risk Factors
  • Withholding Treatment / standards

Substances

  • Angiotensin Receptor Antagonists
  • Angiotensin-Converting Enzyme Inhibitors
  • Anti-Inflammatory Agents, Non-Steroidal
  • Diuretics