(2015) Avoidance of polypharmacy and excessive blood pressure control is associated with improved renal function in older patients, Renal Failure, 37:6, 961-965
PubMed link: https://www.ncbi.nlm.nih.gov/pubmed/25962494
Full text article: https://www.tandfonline.com/doi/full/10.3109/0886022X.2015.1044399
| Methods | Study design: Retrospective before-and-after study
Number of groups: 1 |
| Participants | Number of participants: 61
Active group: 61 Age: Median 81(range 60-94) Sex: 36 female (59%) Participants with dementia: Unclear Inclusion criteria: · ≥60 years · Referred to nephrology outpatient clinic · CKD and/or hypertension Exclusion criteria: History of organ transplant Vasculitis Biopsy-proven glomerulonephritis or primary glomerular disease Autoimmune disease, Hospitalisation in previous month Hospital-acquired AKI Renal replacement therapy in the prior month Concomitant medicines: Median 3 antihypertensives (range 0-8) Country: USA Setting: Outpatient nephrology clinic |
| Interventions | Medicine: Antihypertensives, NSAIDs
Intervention: Nephrologists reviewed medication lists and targeted NSAID or antihypertensive use Withdrawal schedule: “discontinued or tapered down” |
| Outcomes | Number of anti-hypertensives
NSAID use Systolic blood pressure Diastolic blood pressure Glomerular filtration rate Mortality |
| Dates | Dates: January 2013 to February 2015
Follow-up duration: Median 99 days (range 28-290) |
| Funding sources | Nil reported |
| Notes | Poorly reported – unclear at what time points outcomes were measured, and ongoing deprescribing success was not reported |
Risk of bias table
| Bias | Authors’ judgment | Support for judgment |
| Random sequence generation (selection bias) | High | Single arm study |
| Allocation concealment (selection bias) | High | Single arm study |
| Blinding of participants and personnel (performance bias) | High | Open study, nephrologists aware. Unknown if patients aware |
| Blinding of outcome assessment (detection bias) | High | Outcome assessors had access to all data. Single arm |
| Incomplete outcome data (attrition bias) | High | High loss to follow-up. Not accounted for in analysis. No mention of missing data or reasons for exclusion/attrition. |
| Selective reporting (reporting bias) | High | No protocol or pre-specified outcomes stated |
| Confounding (non-randomized) | Low | Single arm, multivariate analysis used with confounding variables |
| Other bias | ||
| Selection bias | Representativeness of the exposed cohort | Representative of older adults with CKD disease treated as outpatients |
| Selection of the non-exposed cohort | No non-exposed group | |
| Ascertainment of exposure | Interview | |
| Demonstration that outcome of interest was not present at start of study | Yes | |
| Comparability bias | Comparability of cohorts on the basis of the design or analysis | Controls for age, blood pressure |
| Outcome bias | Assessment of outcome | Records |
| Was follow-up long enough for outcomes to occur | No, recommended 6-12 months | |
| Adequacy of follow-up of cohorts | Follow-up inadequately explained/controlled for | |
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