Dataset Information

Higher anti-depressant dose and major adverse outcomes in moderate chronic kidney disease: a retrospective population-based study.

ABSTRACT:

Background

Many older patients have chronic kidney disease (CKD), and a lower dose of anti-depressants paroxetine, mirtazapine and venlafaxine is recommended in patients with CKD to prevent drug accumulation from reduced elimination. Using information available in large population-based healthcare administrative databases, we conducted this study to determine if ignoring the recommendation and prescribing a higher versus lower dose of anti-depressants associates with a higher risk of adverse events.

Methods

We conducted a population-based cohort study to describe the 30-day risk of delirium in older adults who initiated a higher vs. lower dose of these three anti-depressants in routine care. We defined delirium using the best proxy available in our data sources - hospitalization with an urgent head computed tomography (CT) scan. We determined if CKD status modified the association between anti-depressant dose and outcome, and examined the secondary outcome of 30 day all-cause mortality. We used multivariable logistic regression analyses to estimate adjusted odds ratios (relative risk (RR)) and 95% confidence intervals.

Results

We identified adults (mean age 75) in Ontario who started a new study anti-depressant at a higher dose (n=36,651; 31%) or lower dose (n=81,160; 69%). Initiating a higher vs. lower dose was not associated with an increased risk of hospitalization with head CT (1.09% vs. 1.27% (adjusted RR 0.90; 95% CI, 0.80 to 1.02), but was associated with a lower risk of all-cause mortality (0.76% vs. 0.97% RR 0.82; 95% CI, 0.71 to 0.95). Neither of these relative risks were modified by the presence of CKD (p=0.16, 0.68, respectively).

Conclusions

We did not observe an increase in two adverse outcomes when study anti-depressants were initiated at a higher dose in elderly patients with moderate CKD. Contrary to our hypothesis, the 30-day risk of mortality was lower when a higher versus lower dose of anti-depressant was initiated in these patients, a finding which requires corroboration and further study.

SUBMITTER: Dev V

PROVIDER: S-EPMC4024017 | biostudies-literature | 2014 May

REPOSITORIES: biostudies-literature

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Publications

Higher anti-depressant dose and major adverse outcomes in moderate chronic kidney disease: a retrospective population-based study.

Dev Varun V Dixon Stephanie N SN Fleet Jamie L JL Gandhi Sonja S Gomes Tara T Harel Ziv Z Jain Arsh K AK Shariff Salimah Z SZ Tawadrous Davy D Weir Matthew A MA Garg Amit X AX

BMC nephrology 20140510

<h4>Background</h4>Many older patients have chronic kidney disease (CKD), and a lower dose of anti-depressants paroxetine, mirtazapine and venlafaxine is recommended in patients with CKD to prevent drug accumulation from reduced elimination. Using information available in large population-based healthcare administrative databases, we conducted this study to determine if ignoring the recommendation and prescribing a higher versus lower dose of anti-depressants associates with a higher risk of adv ...[more]

PMID: 24884589

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Dataset Information

Higher anti-depressant dose and major adverse outcomes in moderate chronic kidney disease: a retrospective population-based study.

Background

Methods

Results

Conclusions

Publications

Higher anti-depressant dose and major adverse outcomes in moderate chronic kidney disease: a retrospective population-based study.

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