QT prolonging drugs are commonly given to dialysis patients

Physicians other than nephrologists frequently prescribe QT-prolonging drugs with a known risk of torsade de pointes (TdP) to dialysis-dependent elderly patients, and these prescriptions are often reserved for non-acute settings. A cross-sectional study suggested that this is often the case.

Among Medicare patients with renal failure receiving in-center hemodialysis, 52.9% had an outpatient prescription for one of the seven most frequently prescribed QT prolonging drugs with a known TdP risk. said Jennifer Fleiss, MD, MPH, University of North Carolina Kidney Center. in Chapel Hill, his colleagues reported.

The majority (78.6% to 93.9%) of prescriptions for QT prolonging drugs with known TdP risk occurred outside of acute care, with less than 25% prescribed within 1 week of acute care occurrence. , the researchers wrote. JAMA network open. Most prescriptions (80.2%) were from non-nephrologists.

“We were surprised that so many potentially dangerous drugs were being prescribed in outpatient clinics by non-nephrologists,” Fleiss said. today's med page. “This finding will help us know where and for whom to target interventions.”

These patients were already at higher risk for drug-related harm than the general population due to altered drug metabolism, Fleiss noted, and typically had numerous comorbidities managed by multiple clinicians and prescribed medications. . QT prolonging drugs with a known TdP risk are associated with an increased risk of sudden cardiac death, the leading cause of death in hemodialysis patients.

Clinicians should regularly make drug adjustments and closely monitor drug pairs that may interact, suggested co-author Virginia Wang, Ph.D., of Duke University School of Medicine in Durham, North Carolina. .

“In the health system [level]There are many opportunities to better coordinate care and prevent prescribing of dangerous drugs,” Wang said. today's med page. “This includes intensive clinician education on high-risk drugs, dedicated resources for medication reconciliation, and improved medication monitoring systems and prescription drug planning at compounding pharmacies.”

“Any potential solution requires better information exchange, highlighting the importance of improving communication between clinicians and increasing the interoperability of electronic health data systems,” she said. said.

The analysis included 20,761 Medicare Part A, B, and D beneficiaries receiving in-center hemodialysis in 2019. Approximately 51% were male, and the average age was 74 years. Most patients prescribed drugs with a known TdP risk were prescribed the antibiotic or antifungal drug azithromycin (azithromycin). 30.7%), ondansetron (30.6%), levofloxacin (21.4%), ciprofloxacin (19.3%), amiodarone (14.7%), escitalopram (9.0%), and fluconazole (7.9%).

Compared with nonusers, patients prescribed QT prolonging drugs with known TdP risk were more likely to be female (52.6% vs. 44.7%) and white (56.0% vs. 47.9%). and heart failure (53.1% vs 44.2%), arrhythmia (42.4% vs 33.2%), depression (26.8% vs 16.1%), polypharmacy (65.0% vs 49.6%), and hyperpharmacy (17.7% vs 8.8%). The proportion was also high. %).

Less than 20% of these prescriptions were provided by nephrologists. The majority were from general internal medicine clinicians (36.8% to 61%). The advanced clinician wrote his 13.6% to 19.6% of new prescriptions.

Up to 26.2% of prescriptions for QT prolonging drugs with a known TdP risk occurred in combination with another pharmacodynamically interacting QT prolonging drug.

The researchers noted that this finding is likely “a microcosm of a larger problem of unsafe prescribing practices in individuals receiving maintenance hemodialysis.” They added that future research should examine prescribing patterns for other potentially harmful drugs, such as opioids, benzodiazepines, sedative-hypnotics, and muscle relaxants.

The researchers acknowledged that the study included data only on prescription fillings, not drug use. Additionally, the analysis was descriptive and did not quantify the association between prescription drug taking and adverse outcomes.