(102) Drug Utilization Pattern of Non-Steroidal Anti-Inflammatory Drugs Among Pre-End-Stage Renal Disease Patients in Taiwan

Friday, August 26, 2022

8:00 AM – 6:00 PM CEST

Location: Hall C

Publication Number: 433

Presenting Author(s)

Yuhuan Shih
– NCKU Institute of Clinical Pharmacy and Pharmaceutical Sciences

Co-Author(s)

Ju-Ling Chen
– National Cheng Kung University, Tainan City , Taiwan
Yu-Ching Chang
– Health Outcome Research Center, National Cheng Kung University, Tainan, Taiwan, Taiwan (Republic of China)
Chien-Huei Huang
– Departments of Pharmacy, National Cheng Kung University Hospital, Tainan, Taiwan, Tainan, Taiwan (Republic of China)
Ching-Lan Cheng
– School of Pharmacy and, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan, Taiwan (Republic of China)

Background: Due to high incidence and prevalence rates of end stage renal disease (ESRD), optimal care for pre-ESRD (chronic kidney disease stage 3b-5, CKD 3b-5) patients to delay progression to ESRD has become a priority in Taiwan. Non-steroidal anti-inflammatory drugs (NSAIDs) have been known as nephrotoxic drugs and guidelines suggest NSAIDs should be avoided or do not use for long-term duration in CKD patients. Appropriate use of NSAIDs to avoid preventable adverse events on the kidney needs more attention in pre-ESRD patients. However, limited studies have evaluated drug utilization pattern of NSAIDs in Taiwan pre-ESRD patients.

Objectives: To investigate the drug utilization pattern of NSAIDs in pre-ESRD patients who were enrolled in Taiwan pre-ESRD pay-for-performance program.

Methods: Data from Taiwan National Health Insurance Database, which enrolls about 99% of Taiwan’s population of 23 million, was used to analyze the utilization pattern. Pre-ESRD patients who progressed to ESRD between 2012 and 2017 were included in the study. We excluded patients if they were younger than 20 years old, pregnant women or with medical history of malignancy. NSAIDs users were defined as patients who had at least one recorded prescription of NSAIDs within 1 year before they progressed to ESRD. We assessed patient characteristics between NSAIDs users and NSAIDs non-users which include patient demographics, comorbidities and co-medications. We performed multiple logistic regression models to estimate the risk factors. We further evaluated the utilization pattern of NSAIDs according to accreditation level, medical department, abnormal use of NSAIDs (which was defined as total days of NSAIDs prescribed within 3 months that is more than 30 days), and classification of NSAIDs.

Results: Total 32550 eligible patients were identified, and 17733 of whom were NSAIDs users. According to accreditation level, primary clinics prescribed NSAIDs most frequently (62.7%). The most frequently prescribed medical department was division of family medicine (23.95%). 15.69% patients (2782 patients out of the 17733) used NSAIDs abnormally. By classification of NSAIDs, non-selective NSAIDs were prescribed most frequently (91.41%). Patients with upper respiratory tract infections and influenza [odds ratio (OR)=2.48, 95% confidence interval (CI)=2.37-2.61], osteoarthritis (OR=2.02, 95% CI=1.81-2.26) and fractures (OR=1.98, 95% CI=1.80-2.19) were more likely to increase use of NSAIDs.

Conclusions: Many pre-ESRD patients still use NSAIDs abnormally. Intervention strategies including communicating the nephrotoxicity and interaction of NSAIDs to healthcare professionals as well as providing education for pre-ESRD patients to reduce NSAIDs use are needed.