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Article Dans Une Revue American Journal of Kidney Diseases Année : 2023

Kidney Function Decline and Serious Adverse Drug Reactions in Patients With CKD

Dorothée Cannet
  • Fonction : Auteur
Christian Combe
  • Fonction : Auteur
Denis Fouque
  • Fonction : Auteur
Luc Frimat
  • Fonction : Auteur
Yves-Edouard Herpe
  • Fonction : Auteur
Christian Jacquelinet
  • Fonction : Auteur
Christophe Pascal
  • Fonction : Auteur
Bruce Robinson
  • Fonction : Auteur
Céline Lange
  • Fonction : Auteur
Karine Legrand
  • Fonction : Auteur
Marie Metzger
  • Fonction : Auteur
Elodie Speyer

Résumé

Rationale & Objective Adverse drug reactions (ADRs) are common in patients with chronic kidney disease (CKD). The impact of kidney function decline on serious ADR risk has been poorly investigated. We sought to comprehensively describe ADRs and assess the relationship between eGFR and serious ADR risk. Study Design Prospective cohort study. Setting & Participants 3,033 participants in French Chronic Kidney Disease-Renal Epidemiology and Information Network (CKD-REIN) cohort study, a nationwide sample of nephrology outpatients with moderate-to-advanced CKD. Predictors Demographic and biological data (including eGFR), medication prescriptions. Outcomes ADRs (preventable or not) were prospectively identified from hospital discharge reports, medical records, and patient interviews. Expert pharmacologists used validated tools to adjudicate ADRs. Analytical Approach Restricted cubic splines in fully adjusted cause-specific Cox proportional hazard models were used to evaluate the relationship between eGFR and the risk of serious ADRs (overall and by subtype). Results During a median follow-up period of 4.7 years, 360 patients experienced 488 serious ADRs. Kidney and urinary disorders (n=170) and hemorrhages (n=170) accounted for 70% of serious ADRs. The most common medications classes were antithrombotics and renin-angiotensin system inhibitors. The majority of those serious ADRs were associated with hospitalization (n=467), with 32 directly or indirectly associated with death, and 22 associated with life-threatening event. More than 27% of the 488 serious ADRs were preventable or potentially preventable. The eGFR is a major risk factor for serious ADRs. Risk of AKI was 2.2% higher and risk of bleeding ADRs were 8% higher for each 1 mL/min/1.73m2 lower baseline eGFR. Limitations The results cannot be extrapolated to patients who are not being followed up by a nephrologist. Conclusions ADRs constitute a major cause of hospitalization in CKD patients for whom lower eGFR level is a major risk factor.

Dates et versions

hal-04288693 , version 1 (16-11-2023)

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Citer

Solène Laville, Valérie Gras-Champel, Aghilès Hamroun, Julien Moragny, Oriane Lambert, et al.. Kidney Function Decline and Serious Adverse Drug Reactions in Patients With CKD. American Journal of Kidney Diseases, 2023, ⟨10.1053/j.ajkd.2023.09.012⟩. ⟨hal-04288693⟩
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