Prescribing quality in secondary care patients with different stages of chronic kidney disease: A retrospective study in the Netherlands

Kirsten P. J. Smits, Grigory Sidorenkov, Frans J. van Ittersum, Femke Waanders, Henk J. G. Bilo, Gerjan J. Navis, Petra Denig

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Objectives Insight in the prescribing quality for patients with chronic kidney disease (CKD) in secondary care is limited. The aim of this study is to assess the prescribing quality in secondary care patients with CKD stages 3-5 and possible differences in quality between CKD stages. Design This was a retrospective cohort study. Setting Data were collected at two university (n=569 and n=845) and one non-university nephrology outpatient clinic (n=1718) in the Netherlands. Participants Between March 2015 and August 2016, data were collected from patients with stages 3a-5 CKD seen at the clinics. Blood pressure measurements, laboratory measurements and prescription data were extracted from medical records. For each prescribing quality indicator, patients with incomplete data required for calculation were excluded. Outcome measures Potentially appropriate prescribing of antihypertensives, renin-angiotensin-aldosterone system (RAAS) inhibitors, statins, phosphate binders and potentially inappropriate prescribing according to prevailing guidelines was assessed using prescribing quality indicators. 2 or Fisher's exact tests were used to test for differences in prescribing quality. Results RAAS inhibitors alone or in combination with diuretics (57% or 52%, respectively) and statins (42%) were prescribed less often than phosphate binders (72%) or antihypertensives (94%) when indicated. Active vitamin D was relatively often prescribed when potentially not indicated (19%). Patients with high CKD stages were less likely to receive RAAS inhibitors but more likely to receive statins when indicated than stage 3 CKD patients. They also received more active vitamin D and erythropoietin-stimulating agents when potentially not indicated. Conclusions Priority areas for improvement of prescribing in CKD outpatients include potential underprescribing of RAAS inhibitors and statins, and potential overprescribing of active vitamin D. CKD stage should be taken into account when assessing prescribing quality.
Original languageEnglish
Article numbere025784
JournalBMJ Open
Issue number7
Publication statusPublished - 2019


  • chronic kidney disease
  • prescribing quality
  • quality assessment
  • quality indicator
  • secondary care

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