A recent cross-sectional study conducted by Jennifer Flythe, MD, MPH, and colleagues from the University of North Carolina Kidney Center revealed alarming trends in the prescribing practices of QT-prolonging medications with known torsades de pointes (TdP) risk to older dialysis-dependent patients. The study found that a significant percentage of Medicare patients with kidney failure receiving in-center hemodialysis were prescribed these high-risk medications, with the majority of prescriptions originating from non-nephrologists in nonacute settings.
According to the findings, 52.9% of the patients filled outpatient prescriptions for the seven most frequently filled QT-prolonging medications with known TdP risk. Surprisingly, the majority of these prescriptions (78.6% to 93.9%) were written outside of acute care events, and less than 25% were associated with recent acute care encounters. Moreover, a striking 80.2% of the prescriptions came from non-nephrologists, indicating a lack of awareness or specialized knowledge among clinicians.
Patients on hemodialysis are already at a higher risk for drug-related harms due to altered drug metabolism and multiple comorbid conditions. The study highlighted the potential dangers of prescribing QT-prolonging medications with known TdP risk to this vulnerable population, as these medications have been linked to a higher risk of sudden cardiac death, a leading cause of mortality in hemodialysis patients.
Co-author Virginia Wang, PhD, emphasized the importance of medication reconciliation and vigilance in detecting potentially interacting medications in this population. The study underscored the need for better coordination of care and prevention of risky medication prescriptions through clinician education, dedicated resources for medication reconciliation, and improving medication monitoring systems.
The researchers suggested that the findings of this study may represent a larger issue of risky prescription practices among individuals receiving maintenance hemodialysis. Future studies should explore prescribing patterns of other potentially harmful medications commonly used in this population, such as opioids, benzodiazepines, sedative hypnotics, and muscle relaxants. It is essential to consider the broader implications of prescribing practices on patient outcomes and safety.
The study shed light on the concerning trends in prescribing QT-prolonging medications with known TdP risk to dialysis patients and the urgent need for interventions to improve medication safety and coordination of care in this vulnerable population. By highlighting the risks and implications of these practices, the study provides valuable insights for clinicians, healthcare systems, and policymakers to prioritize patient safety and optimize care delivery for dialysis-dependent patients.
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