Letter to the Editor
Potentially inappropriate prescribing in patients on dialysis using STOPP-START criteria
Prescripción potencialmente inapropiada en pacientes en diálisis utilizando los criterios STOPP-START
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PIP is also considered if doses or duration of treatment are more that optimal, with potential interactions with other medications and with the patient's diseases, also includes therapeutic duplicities. In addition, it is inadequate the omission of medications with established indication in a specific patient.</p><p id="par0010" class="elsevierStylePara elsevierViewall">One of the most used tools in Europe for the detection of PIP is the criteria of Screening Tool of Older Person's inappropriate Prescription (STOPP)/Screening Trial to Alert Doctor to Right Treatment (START) proposed by Gallagher et al. in 2008<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">1</span></a> and accepted by the Spanish Society of Geriatric.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">2</span></a> They have been recently updated with incorporating new data, or the arrival of new drugs and identification of drugs considered potentially inadequate.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">3,4</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">There is little information about PIP in patients with chronic renal failure.<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">5–7</span></a> Therefore, we decided to perform a study aiming to detect systematically the PIP, according to the STOPP/START criteria, in the 103 dialysis patients followed in our hospital. For this, the pharmacotherapeutic records of all these patients were reviewed, considering the following variables shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>: age, sex, number of active ingredients, number of pills, number of prescribing doctors and STOPP/START criteria identified.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">It was found that 69.9% (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>72) of the patients had at least one potentially inappropriate prescription and a total of 231 inappropriate prescriptions were detected (132 START and 99 STOPP).</p><p id="par0025" class="elsevierStylePara elsevierViewall">According to the STOPP criteria (tool for the detection of potentially inappropriate prescriptions) the most frequent causes of PIP were (see <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>): A1 (any prescribed medication without an indication based on evidence); A2 (any prescribed medication with a longer duration than indicated, when the duration of treatment is well defined); D5 (benzodiazepines for more than 4 weeks, without indication); F2 (proton pump inhibitor for more than 8 weeks, without indication). For the START criteria (instrument to call the doctor's attention about treatments that were indicated and appropriate): A3 (absence of antiplatelet agents such as ASA, clopidogrel, prasugrel or ticagrelor in patients with a well-documented history of coronary, cerebral or peripheral vascular disease); A4 (absence of antihypertensive medication if the systolic blood pressure is usually >160<span class="elsevierStyleHsp" style=""></span>mmHg and/or the diastolic blood pressure is usually >90<span class="elsevierStyleHsp" style=""></span>mmHg, and in the case of diabetes mellitus >140<span class="elsevierStyleHsp" style=""></span>mmHg and >90<span class="elsevierStyleHsp" style=""></span>mmHg, respectively); I1 (annual trivalent vaccine against seasonal influenza), and I2 (absence of pneumococcal vaccine every 5 years).</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">Inadequacy was associated with the number of pills (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.031) only for STOPP criteria. It was not related to age, gender or number of prescribing doctors in any of the cases. These results are similar to those obtained in other studies in different populations.<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">5–8</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">The STOPP/START<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">7</span></a> criteria have proven to be a good tool for detecting potentially inadequate prescriptions and improve the quality of treatments in all healthcare settings (including dialysis patients that in general are elderly, multi-pathological and polymedicated), also provides a common language that allows the comparison and the adoption of educational and corrective measures.</p><p id="par0040" class="elsevierStylePara elsevierViewall">The greatest limitation is that these criteria are under the constant evolution of knowledge and exposed to a periodic update.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">7</span></a> It would be desirable to establish specific STOPP/START criteria for patients with chronic kidney disease and/or dialysis.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Gonzalez-Lopez A, Nava-Rebollo A, Chocarro-Martinez A, Andres-Martin B, Santana-Zapatero H, Herrera-Gomez F, et al. Prescripción potencialmente inapropiada en pacientes en diálisis utilizando los criterios STOPP-START. Nefrologia. 2019;39:92–94.</p>" ] ] "multimedia" => array:2 [ 0 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">PIP: potentially inadequate prescription.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Total (103) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Patients with con PIP (72) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Patients without PIP (31) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span> value \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Gender (male) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">68 (66%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">50 (69.4%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">18 (58.1%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.263 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Average age (years) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">72.56 (31–92) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">72.99 (36–90) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">71.58 (31–90–2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.591 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Number of active drugs \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">8.85 (1–19) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">8.66 (1–19) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">9.29 (4–16) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.312 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Number of pills \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">10.46 (2–22) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">10.54 (2–22) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">10.29 (4–20) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.691 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Number of prescribing doctors \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">6.6 (3–13) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">6.7 (3–13) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5.86 (4–8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.549 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1978552.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Characteristics of the studied population (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>103).</p>" ] ] 1 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">PPI: inhibitor of proton pump; PIP: potentially inadequate prescription.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Most frequent PIPs in relation to STOPP criteria \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Number of patients (% total PIP) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Most frequent PIP in relation to START criteria<br> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Number of patients (% total PIP) \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">A1: Any prescribed medication without an indication based on the evidence<br> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">17 (16.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">A3: Antiaggregants (AAS, clopidogrel, prasugrel or ticagrelor) with a well-documented history of coronary, cerebral or peripheral vascular disease) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11 (10.7) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">A2: Any prescribed medication with a longer duration than indicated, when the duration of treatment is well defined<br> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12 (11.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">A4: Absence of antihypertensives when the systolic blood pressure is usually >160<span class="elsevierStyleHsp" style=""></span>mmHg and/or the diastolic blood pressure is usually >90<span class="elsevierStyleHsp" style=""></span>mmHg (>140<span class="elsevierStyleHsp" style=""></span>mmHg and >90<span class="elsevierStyleHsp" style=""></span>mmHg, respectively, if the patient is diabetic) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12 (11.7) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">D5: Benzodiazepines for more than 4 weeks, without indication \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11 (10.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">I1: No annual trivalent vaccine against seasonal influenza \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">31 (30.1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">F2: PPI more than 8 weeks, without indication \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">27 (26.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">I2: Absence of pneumococcal vaccine every 5 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">24 (23.3) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1978551.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">The most common PIP errors according to the STOPP/START criteria.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:8 [ 0 => array:3 [ "identificador" => "bib0045" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "STOPP (Screening Tool of Older Person's Prescriptions) and START (Screening Tool to Alert doctors to Right Treatment). 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 6 | 5 | 11 |
| 2024 October | 34 | 44 | 78 |
| 2024 September | 48 | 46 | 94 |
| 2024 August | 74 | 91 | 165 |
| 2024 July | 41 | 44 | 85 |
| 2024 June | 70 | 50 | 120 |
| 2024 May | 57 | 55 | 112 |
| 2024 April | 57 | 46 | 103 |
| 2024 March | 34 | 34 | 68 |
| 2024 February | 32 | 44 | 76 |
| 2024 January | 25 | 36 | 61 |
| 2023 December | 66 | 43 | 109 |
| 2023 November | 45 | 52 | 97 |
| 2023 October | 102 | 50 | 152 |
| 2023 September | 313 | 45 | 358 |
| 2023 August | 241 | 34 | 275 |
| 2023 July | 56 | 42 | 98 |
| 2023 June | 73 | 36 | 109 |
| 2023 May | 62 | 43 | 105 |
| 2023 April | 26 | 20 | 46 |
| 2023 March | 52 | 39 | 91 |
| 2023 February | 35 | 30 | 65 |
| 2023 January | 32 | 47 | 79 |
| 2022 December | 53 | 41 | 94 |
| 2022 November | 71 | 61 | 132 |
| 2022 October | 63 | 64 | 127 |
| 2022 September | 42 | 52 | 94 |
| 2022 August | 45 | 48 | 93 |
| 2022 July | 42 | 59 | 101 |
| 2022 June | 43 | 51 | 94 |
| 2022 May | 40 | 34 | 74 |
| 2022 April | 54 | 63 | 117 |
| 2022 March | 60 | 46 | 106 |
| 2022 February | 65 | 52 | 117 |
| 2022 January | 40 | 42 | 82 |
| 2021 December | 47 | 51 | 98 |
| 2021 November | 53 | 48 | 101 |
| 2021 October | 43 | 53 | 96 |
| 2021 September | 30 | 47 | 77 |
| 2021 August | 50 | 44 | 94 |
| 2021 July | 32 | 34 | 66 |
| 2021 June | 27 | 28 | 55 |
| 2021 May | 53 | 56 | 109 |
| 2021 April | 459 | 93 | 552 |
| 2021 March | 55 | 37 | 92 |
| 2021 February | 43 | 18 | 61 |
| 2021 January | 46 | 29 | 75 |
| 2020 December | 29 | 18 | 47 |
| 2020 November | 26 | 26 | 52 |
| 2020 October | 35 | 33 | 68 |
| 2020 September | 41 | 17 | 58 |
| 2020 August | 40 | 38 | 78 |
| 2020 July | 27 | 19 | 46 |
| 2020 June | 31 | 27 | 58 |
| 2020 May | 27 | 22 | 49 |
| 2020 April | 31 | 30 | 61 |
| 2020 March | 46 | 24 | 70 |
| 2020 February | 28 | 38 | 66 |
| 2020 January | 81 | 50 | 131 |
| 2019 December | 36 | 47 | 83 |
| 2019 November | 44 | 45 | 89 |
| 2019 October | 51 | 43 | 94 |
| 2019 September | 30 | 44 | 74 |
| 2019 August | 26 | 57 | 83 |
| 2019 July | 33 | 44 | 77 |
| 2019 June | 46 | 41 | 87 |
| 2019 May | 54 | 44 | 98 |
| 2019 April | 98 | 59 | 157 |
| 2019 March | 33 | 25 | 58 |
| 2019 February | 27 | 24 | 51 |
| 2019 January | 36 | 30 | 66 |
| 2018 December | 67 | 56 | 123 |
| 2018 November | 1 | 1 | 2 |
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