Prescription practices among dialysis-dependent patients are under scrutiny due to the potential risks associated with medications that prolong the QT interval and increase the risk of TdP. A recent cross-sectional study revealed alarming trends in prescription patterns among older patients receiving in-center hemodialysis.
The study found that more than half of Medicare patients with kidney failure on in-center hemodialysis filled prescriptions for QT-prolonging medications with known TdP risk. What is concerning is that the majority of these prescriptions were written in nonacute settings, with less than a quarter occurring within 1 week of an acute care event. Furthermore, the majority of these prescriptions came from non-nephrologists, highlighting a gap in specialized care for this vulnerable population.
Patients on dialysis are already at increased risk for drug-related harms due to altered drug metabolism and comorbid conditions. Prescription of medications with known TdP risk further exacerbates this risk, as these medications have been linked to higher rates of sudden cardiac death. Clinicians need to be vigilant in performing medication reconciliation and identifying potential drug interactions that could worsen outcomes for these patients.
To address the concerning trends in prescription practices among dialysis patients, interventions are needed at multiple levels. Clinician education on high-risk medications, resources for medication reconciliation, and improved medication monitoring systems are crucial. Enhancing communication between clinicians and improving the interoperability of electronic health data systems can also help prevent risky prescriptions and improve patient outcomes.
The study included a large cohort of Medicare beneficiaries on in-center hemodialysis, with the majority being male and elderly. Antibacterials and antifungals were among the most commonly prescribed medications with known TdP risk. Patients prescribed these medications had higher rates of comorbidities, polypharmacy, and hyperpharmacy, indicating complex health needs that require careful medication management.
The findings of this study shed light on the challenges faced by dialysis patients in managing their medications and the need for improved prescribing practices. Future research should explore prescription patterns of other potentially harmful medications and their impact on patient outcomes. By addressing prescription practices among dialysis patients, healthcare providers can work towards improving the safety and quality of care for this vulnerable population.
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