Nephrotoxic medication burden and drug-related problems in patients with chronic kidney disease using SGLT2 inhibitors.

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Original abstract

<h4>Background</h4>Sodium-glucose cotransporter 2 inhibitors (SGLT2i) are increasingly prescribed because of their renal and cardiovascular benefits. However, polypharmacy is common among patients with chronic kidney disease (CKD), raising concerns about cumulative nephrotoxic medication exposure. This study aimed to evaluate drug-related problems (DRPs), nephrotoxic medication burden, kidney failure risk, and patient-reported outcomes in patients receiving SGLT2i in a nephrology outpatient clinic.<h4>Methods</h4>This observational study was conducted in a nephrology outpatient clinic of a university hospital between September 2022-February 2023. Patients ≥18 years who were newly prescribed an SGLT2 inhibitor were included. A clinical pharmacist performed comprehensive medication reviews, identified and categorized DRPs using the Pharmaceutical Care Network Europe (PCNE) classification system, and assessed nephrotoxic exposure by a structured nephrotoxicity score based on drug-specific risk categories. Kidney failure risk was estimated using the Kidney Failure Risk Equation, and quality of life was assessed using the KDQOL-36 questionnaire.<h4>Results</h4>Seventy-two patients were included, and 69 DRPs were identified through clinical pharmacist-led medication review. The most common DRPs were inappropriate duration of therapy (20.3%), medication without indication (15.9%), and untreated symptoms (13.0%). Pharmacist's recommendations were highly accepted (85.5%). The median number of nephrotoxic drugs per patient was 2 (IQR:1-3), while the median nephrotoxicity score was 1.5 (IQR: 1-2). No clinically overt nephrotoxic events were observed during follow-up, and nephrotoxicity burden was not significantly associated with estimated kidney failure risk.<h4>Conclusion</h4>This study provides real-world descriptive data on nephrotoxic medication exposure, drug-related problems, and clinical pharmacist-led medication review among CKD patients receiving SGLT2i in a nephrology outpatient setting. Further prospective controlled studies are needed to clarify the clinical impact of pharmacist-led medication review on patient.

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