A systematically collated library of prescribing safety indicators for people with chronic kidney disease
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RESEARCH ARTICLE
Open Access
A systematically collated library of prescribing safety indicators for people with chronic kidney disease Fiona Smith1,2*† , Samantha Hayward1,2,3†, Barnaby Hole1,2,3†, George Kimpton1,2, Christine Sluman1, Penny Whiting2,4 and Fergus Caskey1,2
Abstract Background: People with chronic kidney disease (CKD) have high levels of co-morbidity and polypharmacy placing them at increased risk of prescribing-related harm. Tools for assessing prescribing safety in the general population using prescribing safety indicators (PSIs) have been established. However, people with CKD pose different prescribing challenges to people without kidney disease. Therefore, PSIs designed for use in the general population may not include all PSIs relevant to a CKD population. The aim of this study was to systematically collate a library of PSIs relevant to people with CKD. Methods: A systematic literature search identified papers reporting PSIs. CKD-specific PSIs were extracted and categorised by Anatomical Therapeutic Chemical (ATC) classification codes. Duplicate PSIs were removed to create a final list of CKD-specific PSIs. Results: Nine thousand, eight hundred fifty-two papers were identified by the systematic literature search, of which 511 proceeded to full text screening and 196 papers were identified as reporting PSIs. Following categorisation by ATC code and duplicate removal, 841 unique PSIs formed the final set of CKD-specific PSIs. The five ATC drug classes containing the largest proportion of CKD-specific PSIs were: Cardiovascular system (26%); Nervous system (13.4%); Blood and blood forming organs (12.4%); Alimentary and metabolism (12%); and Anti-infectives for systemic use (11.3%). Conclusion: CKD-specific PSIs could be used alone or alongside general PSIs to assess the safety and quality of prescribing within a CKD population. Keywords: Chronic kidney disease, CKD, Primary care population, Outpatient setting, Prescribing safety, Potentially inappropriate prescribing, Prescribing safety indicators
* Correspondence: [email protected] † Fiona Smith, Samantha Hayward and Barnaby Hole contributed equally and thus joint first authors. 1 North Bristol NHS Trust, Bristol, UK 2 University of Bristol, Bristol, UK Full list of author information is available at the end of the article © The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you wi
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