Use of 2 or more potentially inappropriate medications is associated with kidney function decline in adults with chronic kidney disease (CKD), a new study finds.

Among 43,143 Japanese patients with CKD aged 20 to 74 years, approximately 40% were prescribed at least 1 potentially inappropriate medication as defined by the 2019 American Geriatrics Society (AGS) Beers Criteria. The most common classes of potentially inappropriate medication included pain medications (18.5%), gastrointestinal medications (9.8%), central nervous system medications (8.6%), and cardiovascular medications (8.6%). Endocrine, anticholinergics, and other medication classes were less prescribed.

Approximately 50% of the cohort had hypertension and dyslipidemia, and 16% had diabetes mellitus. The median estimated glomerular filtration rate (eGFR) for the cohort was 52 mL/min/1.73 m² at baseline. In adjusted analyses, use of 2 or 3 or more potentially inappropriate medications was significantly associated with 1.7-fold increased odds of a 30% decline in eGFR, compared with use of fewer than 2 of these medications, Koji Kawakami, MD, PhD, of Kyoto University in Kyoto, Japan, and colleagues reported in Nephron. The investigators could not assess use of over-the-counter medications.

“The findings of our study suggest that exposure to two or more prescriptions of [potentially inappropriate medications] accelerates the progression of CKD,” Dr Kawakami’s team wrote. They emphasized the value of routine assessment of medication use. They noted, for example, that use of nonsteroidal anti-inflammatory drugs (NSAIDs) is a risk factor for acute kidney injury, whereas use proton pump inhibitors may increase the risks for hypomagnesemia, acute kidney injury, and acute interstitial nephritis.

The AGS Beers Criteria panel used a modified Delphi consensus process to recommend medications (marketed in the United States) that should be avoided in older adults, such as those with CKD or frailty. Potentially inappropriate does not mean definitely inappropriate, according to the panel. Rather, the document lists medications for which potential harms outweigh the expected benefits. Clinician judgment, patient characteristics, and shared decision-making still play important roles in which medications clinicians ultimately prescribe or deprescribe for a particular patient. The updated 2023 AGS Beers Criteria were published in May.

Dr Kawakami’s team noted that deprescribing is a thoughtful process. For each patient, clinicians need to reconcile all medications according to indication; assess the appropriateness of each medication considering the risks and benefits of use; assess each medication for eligibility to be discontinued; prioritize medications for discontinuation; and implement and monitor medication discontinuation. The AGS Beers Criteria panel recommended these deprescribing resources.

Disclosure: One study author declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.

References

1. Kimura H, Yoshida S, Takeuchi M, Kawakami K. Impact of potentially inappropriate medications on kidney function in chronic kidney disease: Retrospective cohort study. Nephron. 2023;147(3-4):177-184. doi:10.1159/000526326
2. 2023 American Geriatrics Society Beers Criteria® Update Expert Panel. American Geriatrics Society 2023 updated AGS Beers Criteria® for potentially inappropriate medication use in older adults. J Am Geriatr Soc. Published online May 4, 2023. doi:10.1111/jgs.18372