In addition, the serum creatinine measurements obtained in our databases have been standardized across provincial laboratories, reducing inter-laboratory variation in measurements

In addition, the serum creatinine measurements obtained in our databases have been standardized across provincial laboratories, reducing inter-laboratory variation in measurements. inhibit CNI rate of metabolism and increase the risk of CNI nephrotoxicity, while azithromycin does not. Objective: To determine the rate of recurrence of CNI-macrolide co-prescriptions, the proportion who receive post-prescription monitoring, and the risk of adverse drug events in kidney transplant recipients. Design: Retrospective cohort study. Establishing: We used linked health care databases in Alberta, Canada. Individuals: We included 293 adult kidney transplant recipients from 2008-2015 who have been co-prescribed a CNI and macrolide. Measurements: The primary end result was a composite of all-cause hospitalization, acute kidney injury (creatinine increase 0.3 mg/dL or 1.5 times baseline), or death within 30 days of the macrolide prescription. Methods: We recognized CNI-macrolide co-prescriptions and compared outcomes in those who received clarithromycin/erythromycin versus azithromycin. We used a linear mixed-effects model to examine the mean switch TRV130 HCl (Oliceridine) in serum creatinine and estimated glomerular filtration rate (eGFR). Results: Of the 293 recipients who have been co-prescribed a CNI and a macrolide, 38% (n = 112) were prescribed clarithromycin/erythromycin while 62% (n = 181) were prescribed azithromycin. Compared with azithromycin users, clarithromycin/erythromycin users were less likely to have outpatient serum creatinine monitoring post-prescription (56% vs 69%, = TRV130 HCl (Oliceridine) .03). There was no significant difference in the primary outcome between the 2 organizations (17% vs 11%, = .11); however, the risk of all-cause hospitalization was higher in the clarithromycin/erythromycin group (10% vs 3%, = .02). The mean decrement in eGFR was significantly higher in the clarithromycin/erythromycin versus azithromycin group (?5.4 vs ?1.9 mL/min/1.73 m2, .05). Limitations: We did not have CNI levels to correlate with the timing of CNI-macrolide co-prescriptions. We also did not possess info concerning the indications for macrolide prescriptions. Summary: Clarithromycin and erythromycin were regularly co-prescribed in kidney transplant recipients on CNIs despite known drug interactions. Clarithromycin/erythromycin use was associated with a higher risk of hospitalization compared with azithromycin users. Safer prescribing methods in kidney transplant recipients are warranted. (((value of .05 was used to define statistical significance. A schematic of the study design is definitely offered in Supplemental Number S2. Results Baseline Characteristics There were 293 adult, kidney-only transplant recipients in our cohort who have been co-prescribed a CNI and a macrolide during the study period. Baseline characteristics of the recipients at their index day are demonstrated in Table 1. Almost 40% (n = 112) of recipients were prescribed clarithromycin or erythromycin, while the rest were prescribed azithromycin (n = 181). The median age was 55 years and the median eGFR was 58 mL/min/1.73 m2 at the time of the macrolide prescription. Women were less likely to become TRV130 HCl (Oliceridine) prescribed Gdnf clarithromycin or erythromycin compared with azithromycin (37% vs 53%, = .006). Diabetes mellitus was also reduced clarithromycin or erythromycin users compared with azithromycin users (26% vs 40%, = .01). Of the identifiable physicians, over half of the clarithromycin or erythromycin prescriptions were from general practitioners and the majority occurred in the earlier eras (2008-2013 vs 2014-2015). In contrast, nephrologists prescribed the majority of baseline ACE inhibitors, ARBs, and statins compared with general practitioners (59.3% vs 6.2%, 53.0% vs 9.6%, and 58.9% vs 6.6%, respectively). Recipients who have been prescribed clarithromycin or erythromycin were more likely to be on mycophenolate mofetil and an ACE inhibitor and less likely to become on azathioprine, compared with recipients who have been prescribed azithromycin. Table 1. Baseline Characteristics of Kidney Transplant Recipients Co-Prescribed a Calcineurin Inhibitor and a Macrolide. valueData are offered as n (%) or median (interquartile range). eGFR = estimated glomerular filtration rate; PCI = percutaneous coronary treatment; CABG, coronary artery bypass graft; TIA = transient ischemic assault; MMF = mycophenolate mofetil; ACE = angiotensin-converting enzyme; ARB = angiotensin receptor blocker; CaCB = calcium channel blocker; NSAIDs = nonsteroidal anti-inflammatory TRV130 HCl (Oliceridine) medicines; ACR = albumin-creatinine percentage; PCR = protein-creatinine percentage; CKD-EPI = Chronic Kidney Disease Epidemiology Collaboration equation; KDIGO = Kidney Disease: Improving Global Results. aIncome was classified relating to fifths of average neighborhood income (1 = least expensive, 5 = highest). bUrban location indicates a human population 10 000 or human population 1000 with human population denseness 400/km2. cFifty-three recipients in the beginning identified as missing were able to become re-classified to hemodialysis (n = 33) and peritoneal dialysis (n = 20) after assessing for presence of dialysis codes. dFor common recipients as of January 2001 whose day of transplant could not become identified (n = 27), the day of transplant was arranged to April 1, 1994. eMean serum creatinine and eGFR and median albuminuria (ACR, PCR, or urine dipstick) were determined using all outpatient measurements within 6 months before and including the index day. eGFR was determined using the CKD-EPI equation.32.