title: The burden of nephrotoxic drug prescriptions in patients with chronic kidney disease: a retrospective population-based study in Southern Italy.
abstract: BACKGROUND
  The use of nephrotoxic drugs can further worsening renal function in chronic kidney disease (CKD) patients. It is therefore imperative to explore prescribing practices that can negatively affect CKD patients.
  
  
  OBJECTIVE
  To analyze the use of nephrotoxic drugs in CKD patients in a general population of Southern Italy during the years 2006-2011.
  
  
  METHODS
  The general practice "Arianna" database contains data from 158,510 persons, registered with 123 general practitioners (GPs) of Caserta. CKD patients were identified searching: CKD-related ICD-9 CM codes among causes of hospitalization; CKD-relevant procedures undergone in hospital (e.g. dialysis); drug prescriptions issued for a CKD-related indication. A list of nephrotoxic drugs was compiled and validated by pharmacologists and nephrologists. The summary of product characteristics was used to classify drugs as 'contraindicated' or 'to be used with caution' in renal diseases. Frequency of nephrotoxic drug use, overall, by drug class and single compounds, by GPs within one year prior or after first CKD diagnosis and within one year after dialysis entry was calculated.
  
  
  RESULTS
  Overall, 1,989 CKD patients and 112 dialysed patients were identified. Among CKD patients, 49.8% and 45.2% received at least one prescription for a contraindicated nephrotoxic drug within one year prior or after first CKD diagnosis, respectively. In detail, 1,119 CKD patients (56.3%) had at least one nonsteroidal anti-inflammatory drugs (NSAIDs) prescription between CKD diagnosis and end of follow-up. A large proportion of CKD patients (35.6%) were treated with NSAIDs for periods exceeding 90 days. Contraindicated nephrotoxic drugs were used commonly in CKD, with nimesulide (16.6%) and diclofenac (11.0%) being most frequently used.
  
  
  CONCLUSIONS
  Contraindicated nephrotoxic drugs were highly prescribed in CKD patients from a general population of Southern Italy. CKD diagnosis did not seem to reduce significantly the prescription of nephrotoxic drugs, which may increase the risk of preventable renal function deterioration.
authors.affiliation: Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy.
authors.forename: Ylenia
authors.initials: Y
authors.lastname: Ingrasciotta
authors.affiliation: Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy.
authors.forename: Janet
authors.initials: J
authors.lastname: Sultana
authors.affiliation: Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Giorgianni
authors.affiliation: Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy.
authors.forename: Achille Patrizio
authors.initials: AP
authors.lastname: Caputi
authors.affiliation: Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Arcoraci
authors.affiliation: Caserta Local Health Service, Caserta, Italy.
authors.forename: Daniele Ugo
authors.initials: DU
authors.lastname: Tari
authors.affiliation: Caserta Local Health Service, Caserta, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Linguiti
authors.affiliation: Caserta Local Health Service, Caserta, Italy.
authors.forename: Margherita
authors.initials: M
authors.lastname: Perrotta
authors.affiliation: Department of Cognitive Science, Educational and Cultural Studies (CSECS), University of Messina, Messina, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Nucita
authors.affiliation: Unit of Biostatistics, IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo (FG), Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Pellegrini
authors.affiliation: Unit of Biostatistics, IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo (FG), Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Fontana
authors.affiliation: Division of Rheumatology, University and IRCCS Foundation Policlinico S. Matteo, Pavia, Italy.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Cavagna
authors.affiliation: Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy.
authors.forename: Domenico
authors.initials: D
authors.lastname: Santoro
authors.affiliation: Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy.
authors.forename: Gianluca
authors.initials: G
authors.lastname: Trifirò
mesh_terms: D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D015331:Cohort Studies; D000075202:Contraindications; D004008:Diclofenac; D006801:Humans; D007558:Italy / Q000453:epidemiology; D007668:Kidney / Q000187:drug effects*; D016347:Medical Records Systems, Computerized; D055656:Prescriptions / Q000706:statistics & numerical data*; D051436:Renal Insufficiency, Chronic / Q000188:drug therapy* / Q000453:epidemiology*; D012189:Retrospective Studies; D013449:Sulfonamides
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D013449:Sulfonamides; D004008:Diclofenac; C012655:nimesulide