{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,30]],"date-time":"2025-10-30T22:51:54Z","timestamp":1761864714026,"version":"build-2065373602"},"reference-count":47,"publisher":"American Society of Consultant Pharmacists","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["sr care pharm"],"published-print":{"date-parts":[[2025,6,1]]},"abstract":"<jats:p><jats:bold>Background<\/jats:bold> An estimated 14% of U.S. adults are affected by CKD, of whom about 34% are aged 65 years or older. Certain prescribed or over-the-counter medications can exacerbate or help slow CKD progression.  <jats:bold>Objective<\/jats:bold> To evaluate prescriptions or recommendations\n for potentially beneficial and harmful medications in patients with CKD.  <jats:bold>Design<\/jats:bold> Retrospective, cross-sectional analysis of medical records from U.S. office-based physician visits.  <jats:bold>Setting<\/jats:bold> National Ambulatory Medical Care Survey, visits made by patients\n with CKD, 2014-2019.  <jats:bold>Interventions<\/jats:bold> Comparison of rates and predictors for potentially beneficial versus potentially harmful medications including both prescribed and recommended over-the-counter agents.  <jats:bold>Methods<\/jats:bold> CKD and related comorbidities were identified\n using indicators collected from the record regardless of the reason for the sampled visit. Medication classification was based on current guidelines and studies. Analyses included descriptive statistics of patient characteristics and predictors of beneficial versus harmful medication prescriptions\/\n recommendations.  <jats:bold>Results<\/jats:bold> A total of 2,805 adult patients with a diagnosis of CKD were sampled. A plurality were aged 75 years or older (47.4%); majorities were White non-Hispanic (64.0%) with comorbid hypertension (78.8%). Beneficial medications only were prescribed\/ recommended\n to 12.2% of patients, harmful medications only to 20.6%, a mix of beneficial\/ harmful medications to 26.7%, and neither to 40.5%. Strong positive predictors of potentially harmful medication prescriptions\/recommendations included polypharmacy and diagnoses of cerebrovascular disease or congestive\n heart failure.  <jats:bold>Discussion<\/jats:bold> Prescribing patterns for patients with CKD highlight the importance of medication optimization to balance therapeutic benefits and harms.  <jats:bold>Conclusion<\/jats:bold> Pharmacists can educate providers to improve prescribing practices in patients\n with CKD.<\/jats:p>","DOI":"10.4140\/tcp.n.2025.255","type":"journal-article","created":{"date-parts":[[2025,6,14]],"date-time":"2025-06-14T04:32:02Z","timestamp":1749875522000},"page":"255-270","source":"Crossref","is-referenced-by-count":0,"title":["Utilization Rates of Beneficial and Potentially Harmful Medications in the Outpatient Management of Chronic Kidney Disease"],"prefix":"10.4140","volume":"40","author":[{"given":"Andrea","family":"Callas","sequence":"first","affiliation":[{"name":"Midwestern University College of Pharmacy, Glendale Campus, Glendale, Arizona."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kelsey","family":"Buckley","sequence":"additional","affiliation":[{"name":"Midwestern University College of Pharmacy, Glendale Campus, Glendale, Arizona."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicole K.","family":"Early","sequence":"additional","affiliation":[{"name":"Midwestern University College of Pharmacy, Glendale Campus, Glendale, Arizona."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kathleen A.","family":"Fairman","sequence":"additional","affiliation":[{"name":"Midwestern University College of Pharmacy, Glendale Campus, Glendale, Arizona."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2625","reference":[{"year":"2023","key":"ref1"},{"issue":"12","key":"ref2","doi-asserted-by":"crossref","first-page":"1379","DOI":"10.1093\/gerona\/gls173","article-title":"Epidemiology of chronic kidney disease among older adults: a focus on the oldest old.","volume":"67","year":"2012","journal-title":"J Gerontol A Biol Sci Med Sci."},{"issue":"3","key":"ref3","doi-asserted-by":"crossref","first-page":"170","DOI":"10.1016\/j.mpmed.2022.12.004","article-title":"Non-pharmacological management of chronic kidney disease.","volume":"51","year":"2023","journal-title":"Medicine."},{"issue":"3","key":"ref4","first-page":"9599","volume":"10","year":"2019","journal-title":". J Adv Pharm Technol Res."},{"year":"2023","key":"ref5","article-title":"Chronic kidney disease initiative: prevention and risk management."},{"issue":"5S","key":"ref6","article-title":"KDIGO 2022 clinical practice guideline for diabetes management in chronic kidney disease.","volume":"102","year":"2022","journal-title":"Kidney Int."},{"issue":"6","key":"ref7","first-page":"1269","article-title":"ACC\/AHA\/AAPA\/ABC\/ACPM\/AGS\/APhA\/ASH\/ASPC\/NMA\/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology\/American Heart Association Task Force on Clinical Practice Guidelines.","volume":"71","year":"2017","journal-title":"Hypertension."},{"issue":"12","key":"ref8","first-page":"30753090","article-title":"Diabetes management in chronic kidney disease: a consensus report by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO).","volume":"45","year":"2022","journal-title":"Diabetes Care."},{"issue":"4S","key":"ref9","article-title":"KDIGO 2024 clinical practice guideline for the evaluation and management of chronic kidney disease.","volume":"105","year":"2024","journal-title":"Kidney Int."},{"issue":"7","key":"ref10","doi-asserted-by":"crossref","first-page":"2052","DOI":"10.1111\/jgs.18372","article-title":"updated AGS Beers Criteria\u00ae for potentially inappropriate medication use in older adults.","volume":"71","year":"2023","journal-title":"J Am Geriatr Soc."},{"key":"ref11","doi-asserted-by":"crossref","first-page":"275","DOI":"10.2147\/CLEP.S397415","article-title":"Twenty-three-year trends in the use of potentially nephrotoxic drugs in Denmark.","volume":"15","year":"2023","journal-title":"Clin Epidemiol."},{"issue":"4","key":"ref12","doi-asserted-by":"crossref","first-page":"706","DOI":"10.1053\/j.gastro.2017.01.031","article-title":"The risks and benefits of long-term use of proton pump inhibitors: expert review and best practice advice from the American Gastroenterological Association.","volume":"152","year":"2017","journal-title":"Gastroenterology."},{"issue":"2","key":"ref13","doi-asserted-by":"crossref","first-page":"303","DOI":"10.1016\/j.ccc.2020.11.002","article-title":"Nephrotoxin stewardship.","volume":"37","year":"2021","journal-title":"Crit Care Clin."},{"issue":"5","key":"ref14","doi-asserted-by":"crossref","first-page":"804","DOI":"10.1053\/j.ajkd.2005.02.010","article-title":"Antiviral drug-induced nephrotoxicity.","volume":"45","year":"2005","journal-title":"Am J Kidney Dis."},{"issue":"2","key":"ref15","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1111\/bcpt.13758","article-title":"Lithium and the risk of chronic kidney disease: a population-based case-control study.","volume":"131","year":"2022","journal-title":"Basic Clin Pharmacol Toxicol."},{"key":"ref16","first-page":"1","article-title":"KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease.","volume":"3","journal-title":"Kidney Int Suppl."},{"issue":"1","key":"ref17","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s40345-020-00204-2","article-title":"Chronic kidney disease in lithium-treated patients, incidence and rate of decline.","volume":"9","year":"2021","journal-title":"Int J Bipolar Disord."},{"issue":"7","key":"ref18","doi-asserted-by":"crossref","first-page":"1051","DOI":"10.3109\/0886022X.2014.917560","article-title":"Diuretics associated acute kidney injury: clinical and pathological analysis.","volume":"36","year":"2014","journal-title":"Ren Fail."},{"issue":"11","key":"ref19","doi-asserted-by":"crossref","first-page":"1738","DOI":"10.2215\/CJN.00580118","article-title":"Medication safety principles and practice in CKD.","volume":"13","year":"2018","journal-title":"Clin J Am Soc Nephrol."},{"issue":"1","key":"ref20","first-page":"7","article-title":"Epidemiology of chronic kidney disease: an update 2022.","volume":"12","year":"2011","journal-title":"Kidney Int Suppl"},{"key":"ref21","article-title":"National Ambulatory Medical Care Survey: 2019 NAMCS Micro-data File Documentation."},{"year":"2024","key":"ref22","article-title":"National Ambulatory Medical Care Survey: 2014 NAMCS Micro-data File Documentation."},{"year":"2023","key":"ref23","article-title":"NAMCS Scope and Sample Design."},{"year":"2024","key":"ref24","article-title":"List of publications using data from NAMCS and NHAMCS."},{"year":"2023","key":"ref25","article-title":"Angiotensin-converting enzyme (ACE) inhibitors & angiotensin receptor blockers (ARBs)."},{"key":"ref26","first-page":"49","article-title":"Outpatient, combined use of opioid and benzodiazepine medications in the United States, 1993-2014.","volume":"9","year":"2017","journal-title":"Prev Med Rep."},{"issue":"12","key":"ref27","first-page":"556","volume":"35","year":"2015","journal-title":"Sr Care Pharm."},{"key":"ref28","doi-asserted-by":"crossref","first-page":"471","DOI":"10.1016\/j.jad.2024.09.088","article-title":"Depression prevalence, screening, and treatment in adult outpatients with type 1 and type 2 diabetes: a nationally representative cross-sectional study (National Ambulatory Medical Care Survey 2014-2019.","volume":"368","year":"2025","journal-title":"J Affect Disord."},{"issue":"18","key":"ref29","first-page":"e895","article-title":"AHA\/ ACC\/HFSA guideline for the management of heart failure: a report of the American College of Cardiology\/American Heart Association Joint Committee on Clinical Practice Guidelines.","volume":"145","year":"2022","journal-title":"Circulation."},{"issue":"1","key":"ref30","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1007\/s11892-021-01442-z","article-title":"Renal protection with SGLT2 Inhibitors: effects in acute and chronic kidney disease.","volume":"22","year":"2022","journal-title":"Curr Diab Rep."},{"issue":"2","key":"ref31","first-page":"97","article-title":"Polypharmacy among the elderly.","volume":"9","year":"2018","journal-title":"J Midlife Health."},{"year":"2024","key":"ref32","article-title":"Charlson Comorbidity Index (CCI). MDCalc."},{"key":"ref33","first-page":"1","article-title":"Healthy People 2010 criteria for data suppression.","volume":"24","journal-title":"Healthy People 2010 Stat Notes."},{"issue":"200","key":"ref34","article-title":"National Center for Health Statistics data presentation standards for rates and counts.","volume":"2","year":"2023","journal-title":"Vital Health Stat."},{"issue":"5","key":"ref35","doi-asserted-by":"crossref","first-page":"406","DOI":"10.1097\/MNH.0000000000000814","article-title":"Revisiting diuretic choice in chronic kidney disease.","volume":"31","year":"2022","journal-title":"Curr Opin Nephrol Hypertens."},{"issue":"7","key":"ref36","first-page":"e364","article-title":"Guideline for the prevention of stroke in patients with stroke and transient ischemic attack: a guideline from the American Heart Association\/American Stroke Association.","volume":"52","year":"2021","journal-title":"Stroke."},{"issue":"2","key":"ref37","doi-asserted-by":"crossref","first-page":"97","DOI":"10.4103\/jmh.JMH_87_17","article-title":"Polypharmacy among the elderly.","volume":"9","year":"2018","journal-title":"J Mid-life Health"},{"issue":"9","key":"ref38","doi-asserted-by":"crossref","first-page":"1510","DOI":"10.34067\/KID.0001942021","article-title":"Less is More: Deprescribing Medications in Older Adults with Kidney Disease: A Review.","volume":"2","year":"2021","journal-title":"Kidney. 360."},{"year":"2023","key":"ref39","article-title":"Story of discovery: SGLT2 inhibitors: harnessing the kidneys to help treat diabetes."},{"issue":"4","key":"ref40","doi-asserted-by":"crossref","first-page":"100608","DOI":"10.1016\/j.xkme.2023.100608","article-title":"Sodium Glucose Cotransporter (SGLT2) inhibitors and CKD: are you a #flozinator?.","volume":"5","year":"2023","journal-title":"Kidney Med."},{"issue":"9","key":"ref41","article-title":"Effects of dapagliflozin in chronic kidney disease, with and without other cardiovascular medications: DAPA-CKD Trial.","volume":"12","year":"2023","journal-title":"J Am Heart Assoc."},{"issue":"7","key":"ref42","doi-asserted-by":"crossref","first-page":"2003","DOI":"10.1007\/s11606-020-05773-7","article-title":"Use of primary care and specialty providers: findings from the Medical Expenditure Panel Survey.","volume":"35","year":"2020","journal-title":"J Gen Intern Med."},{"issue":"8","key":"ref43","article-title":"Primary care physicians\u2019 perceptions of barriers and facilitators to management of chronic kidney disease: a mixed methods study.","volume":"14","year":"2019","journal-title":"PLoS One."},{"issue":"2","key":"ref44","first-page":"681","article-title":"\u201cPositive kidney health\u201d: implementation and design of a pharmacist-led intervention for patients at risk for development or progression of chronic kidney disease.","volume":"63","year":"2003","journal-title":"J Am Pharm Assoc."},{"issue":"5","key":"ref45","doi-asserted-by":"crossref","first-page":"498","DOI":"10.1097\/MNH.0b013e32834902c8","article-title":"Role of collaborative care models including pharmacists in improving blood pressure management in chronic kidney disease patients.","volume":"20","year":"2011","journal-title":"Curr Opin Nephrol Hypertens."},{"key":"ref46","article-title":"NSAID-avoidance education in community pharmacies for patients at high risk for acute kidney injury, upstate New York, 2011.","volume":"11","year":"2014","journal-title":"Prev Chronic Dis."},{"issue":"12","key":"ref47","first-page":"776","article-title":"Chronic kidney disease: detection and evaluation.","volume":"96","year":"2017","journal-title":"Am Fam Physician."}],"container-title":["The Senior Care Pharmacist"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ingentaconnect.com\/content\/ascp\/tscp\/2025\/00000040\/00000006\/art00004","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,7,8]],"date-time":"2025-07-08T04:32:05Z","timestamp":1751949125000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ingentaconnect.com\/content\/10.4140\/TCP.n.2025.255"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6,1]]},"references-count":47,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2025,6,1]]}},"alternative-id":["2639-9636(20250601)40:6L.255;1-"],"URL":"https:\/\/doi.org\/10.4140\/tcp.n.2025.255","relation":{},"ISSN":["2639-9636"],"issn-type":[{"type":"print","value":"2639-9636"}],"subject":[],"published":{"date-parts":[[2025,6,1]]}}}