title: Prescribing patterns of non-steroidal anti-inflammatory drugs in chronic kidney disease patients in the South African private sector.
abstract: Background Non-steroidal anti-inflammatory drugs (NSAIDs) are among the most commonly used pharmaceutical agents worldwide. NSAIDs are considered nephrotoxic and should therefore be used with caution or be avoided completely in high risk patients, such as chronic kidney disease (CKD) patients. Objective This study aimed to investigate the prescribing of NSAIDs in CKD patients in order to generate awareness and improve the outcome of these patients. Setting The study was conducted using medicine claims data in the private health sector of South Africa. Method A descriptive, quantitative study was performed, using retrospective data obtained from a Pharmaceutical Benefit Management company. Data from 1 January 2009 to 31 December 2013 were analysed. The study population consisted of all patients with an ICD-10 code for a CKD (N18), in association with a paid claim for an NSAID. Main outcome measure The stratification of NSAID prescribing volume among the CKD population in terms of gender, age, NSAID type, dosage and prescriber type. Results The prescribing of NSAIDs in CKD patients varied between 26 and 40 % over the 5 year study period. No association between gender and CKD patients who received NSAIDs versus those who did not was found, with p > 0.05 and Cramer's V < 0.1 for each year of the study. The association between age groups and CKD patients who received NSAIDs versus those who did not was statistically significant, but practically weak (p < 0.05; Cramer's V ≥ 0.1). Most NSAID prescriptions (52-63 %) were for patients aged 35-64 years. Diclofenac (34.25 %) was the single most frequently prescribed NSAID, but the COX-2-inhibitors (celecoxib, meloxicam and etoricoxib) were the preferred NSAID class to be prescribed. The majority (61.6 %) of the NSAIDs were prescribed by general medical practitioners in dosages meeting and even exceeding the recommended daily dosage of patients with normal kidney function. Conclusions Even though NSAIDs are regarded as nephrotoxic drugs, they are still being prescribed to at-risk CKD patients, in particular, the elderly.
authors.affiliation: Medicine Usage in South Africa, Faculty of Health Sciences, North-West University, Potchefstroom, 2531, South Africa.
authors.forename: Willem P
authors.initials: WP
authors.lastname: Meuwesen
authors.affiliation: Medicine Usage in South Africa, Faculty of Health Sciences, North-West University, Potchefstroom, 2531, South Africa. jesslee.duplessis@nwu.ac.za.
authors.forename: Jesslee M
authors.initials: JM
authors.lastname: du Plessis
authors.affiliation: Medicine Usage in South Africa, Faculty of Health Sciences, North-West University, Potchefstroom, 2531, South Africa.
authors.forename: Johanita R
authors.initials: JR
authors.lastname: Burger
authors.affiliation: Medicine Usage in South Africa, Faculty of Health Sciences, North-West University, Potchefstroom, 2531, South Africa.
authors.forename: Martie S
authors.initials: MS
authors.lastname: Lubbe
authors.affiliation: Medicine Usage in South Africa, Faculty of Health Sciences, North-West University, Potchefstroom, 2531, South Africa.
authors.forename: Marike
authors.initials: M
authors.lastname: Cockeran
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D004363:Drug Utilization / Q000706:statistics & numerical data / Q000639:trends*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data* / Q000639:trends*; D017149:Private Sector / Q000639:trends*; D051436:Renal Insufficiency, Chronic / Q000188:drug therapy*; D012189:Retrospective Studies; D012737:Sex Factors; D013019:South Africa; D055815:Young Adult
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal
keywords: Chronic kidney disease; NSAIDs; Non-steroidal anti-inflammatory drugs; Private health sector; South Africa