Use of antibiotics in patients with chronic kidney disease: evidence from the real world.

BACKGROUND

Most antibiotics require dose adjustments in patients with chronic kidney disease (CKD) to avoid accumulation and toxicity. The aim was to characterize the use of systemic antibiotics in a group of patients with CKD and to adjust the dose according to the glomerular filtration rate (GFR).

RESEARCH DESIGN AND

METHODS

Observational study of patients with a diagnosis of CKD who received antibiotics between January-2021 July 2022. The Lexicomp® database was used to determine the dose adjustment according to the GFR.

RESULTS

A total of 473 patients were included, average age of 72.6 years. Patients with CKD were in stage 3 (38.5%), stage 4 (23.5%), or stage 5 (38.1%). Cephalosporins (56.2%), penicillins (43.3%), and glycopeptides (20.3%) were the most widely used antibiotics. A total of 914 antibiotics were used, of which 39.5% did not require dose adjustment, 30.4% had no dose adjustment, and 30.1% had dose adjustment. Treatment with glycopeptides (adjusted Odds Ratio [aOR]:3.86; 95%CI:1.57-9.47), treatment with carbapenems (aOR:4.59; 95%CI:1.75-12.07), stage-4 CKD (aOR:31.61; 95%CI:9.77-102.29), and stage-5 CKD (aOR:21.29; 95%CI:3.66-123.61) increased the probability of receiving antibiotics without dose adjustment according to the GFR.

CONCLUSIONS

Almost one-third of the antibiotics used in this group of patients had no dose adjustment, which generates a significant risk of toxicity and the need to identify CKD in a timely manner and the appropriate use of antibiotics.