Adverse safety events in patients with Chronic Kidney Disease (CKD)

ABSTRACT

Introduction: Chronic kidney disease (CKD) confers a higher risk of adverse safety events as a result of many factors including medication dosing errors and use of nephrotoxic drugs, which can cause kidney injury and renal function decline. CKD patients may also have comorbidities such as hypertension and diabetes for which they require more frequent care from different providers, and for which standard, but countervailing treatments, may put them at risk for adverse safety events.

Areas covered: In addition to the well-known agents such as iodinated radiocontrast, antimicrobials, diuretics and angiotensin converting enzyme (ACE) inhibitors which can directly affect renal function, safety considerations in the treatment of common CKD complications such as anemia, diabetes, analgesia and thrombosis will also be discussed.

Expert opinion: Better outcomes in CKD may be achieved by alerting care providers to the special care needs of kidney patients and encouraging patients to self-manage their disease with the decision support of multidisciplinary patient care teams.

KEYWORDS:

• Patient safety
• adverse events
• CKD
• eGFR
• ACE inhibitors
• ARBs
• hypoglycemia
• anticoagulants
• diuretics
• opioids
• nephrotoxicity
• self-management and patient care teams

Article highlights

• CKD patients have a high risk of adverse safety events due to multiple factors including co-morbidities and need for polypharmacy, which in turn can contribute to progression to kidney failure.

• Early recognition of CKD and inclusion of a patient’s estimated glomerular filtration rate (eGFR) in medication prescribing are important in avoiding dosing errors.

• CKD patients’ limited renal reserve increase their susceptibility to nephrotoxic agents.

• Patients should be educated on potential adverse events associated and safe CKD management.

• Encouraging and supporting self-management of patients with CKD may reduce patient safety adverse events.

This box summarizes key points contained in the article.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Additional information

Funding

This paper was not funded