• Wed. Sep 27th, 2023

Bates, David M


Oct 10, 2021

Bates, David M. X-Gluc Dicyclohexylamine one-year risk of emergency department (ED) visit or hospitalization. We evaluated an observational cohort of 8,217 individuals with stage 3C5 non-dialysis CKD newly prescribed a RAASi (52.3%) or diuretic (47.7%) from thirty-six primary care offices affiliated with Brigham and Women’s Hospital and Massachusetts General Hospital between 2009 and Rabbit Polyclonal to CD40 2011. Overall, 3306 (40.2%) individuals did not have pre-prescription labs done within 2 weeks, and 5957 (72.5%) did not have post-prescription labs done within 2 weeks which includes 524 (6.4%) individuals without post-prescription within 1 year. Close monitoring occurred in only 1547 (20.1%) and was more likely in individuals prescribed diuretics compared to RAASi (adjusted OR 1.39; 95%CI 1.20C1.62), with CKD stage 4,5 compared with stage 3 (adjusted OR 1.47; 95%CI 1.16C1.86) and with cardiovascular disease (adjusted OR 1.42; 95%CI 1.21C1.66). Close monitoring was not associated with decreased risk of ED visit or hospitalization. Close lab monitoring during initiation of RAASi or diuretics was more common in participants with cardiovascular disease and advanced CKD suggesting physicians selected high-risk individuals for close monitoring. As nearly 80% of individuals did not receive close lab monitoring there may be value in future research on electronic physician decision tools targeted at lab monitoring. assessments for normally distributed continuous variables and Pearson 2 assessments for categorical variables were used to compare baseline demographics, comorbidities, and lab values between groups. Trend tests were used for race, insurance, and CKD stage. The frequency and time intervals of pre- and post-prescription lab monitoring were described as continuous variables with the proportion occurring within 2 weeks of the prescription date also reported. 2 assessments were used to compare proportions in CKD stage 3 compared with and stages 4/5. Logistic regression was used to determine predictors of close lab monitoring using univariate models and a multivariate model adjusting for demographics, CKD stage, comorbidities, baseline hyperkalemia, baseline hypokalemia, and medication type in the model. ED visit or hospitalization within 365 days of incident prescription were compared using logistic regression with lab monitoring, CKD stage, baseline potassium, and medication type as predictors. A competing risk model with the Fine and Gray method[12] including death as a competing risk was used to test associations of close monitoring with time to ED visit or hospitalization. This analysis accounts for a diminishing risk set from censoring due to mortality and is utilized in CKD cohort studies where mortality rates are often high.[13,14] Subgroup analyses were conducted by CKD stage 3C5. All analyses were run in STATA 14.2 using a two-sided value of <.05 for significance. 3.?Results 3.1. Study populace Among 8,217 individuals with X-Gluc Dicyclohexylamine stage 3C5 CKD non-dialysis (mean age 72??13.4 years, 43.9% male, 86.4% white, 91.3% CKD stage 3) 52.3% were newly prescribed a RAASi and 47.7% a diuretic (Table ?(Table1,1, Supplemental Table 1). There were 54 individuals excluded because of end stage renal disease (eGFR 10?ml/min/1.73 m2 or baseline serum creatinine >6?mg/dL) (Fig. ?(Fig.1).1). Data were complete for all those baseline variables except race and potassium (2.2% and 1.0% missing respectively). Table 1 Baseline Characteristics of the Study. Open in a separate window Open in a separate window Physique 1 Study flow diagram. eGFR?=?estimated glomerular filtration rate, RAASi?=?Renin angiotensin aldosterone system inhibitors. All follow up labs were within 365 days of the prescription date. Combination RAASi and diuretic n?=?328 (4.0%). 3.2. Pre- and post-prescription lab monitoring Pre-prescription lab monitoring was not done within 2 weeks in 3,306 (40.2%) while post-prescription monitoring was not done within 2 weeks in 5957 (72.5%) which includes 524 (6.4%) individuals without post-prescription within 1 year. Close lab monitoring with pre- and post-prescription X-Gluc Dicyclohexylamine lab monitoring within 2 weeks was present X-Gluc Dicyclohexylamine in only 1547 (20.1%). There was a pattern towards closer monitoring with more severe CKD (Table ?(Table2).2). The proportion of post prescription lab monitoring done 6 weeks after a prescription was 44.8% in the total population and declined with more advanced CKD (P?