by Karolinska Institutet

Credit: Diana ✨ from Pexels

One in ten adults suffer from chronic kidney disease (CKD), a condition characterized by progressive loss of kidney function. Altered kidney function can impact the risk/benefit of many medications. People with advanced chronic kidney disease have to be careful about the medications they take because their kidneys don't work as well as they should. Some medications are not safe at all, while others require dose adjustments or strict monitoring for safety.

The extent to which potentially inappropriate medications or monitoring is given to people with CKD has not been sufficiently evaluated, particularly in Swedish health care. In his thesis, doctoral student Alessandro Bosi at the Department of Medical Epidemiology and Biostatistics, has therefore studied the potential nephrotoxicity of medications and the risk-benefit profiles of treatments in people with CKD through an epidemiological analysis of health care data. Here, Bosi discusses his thesis:

What are the most important results of your study?

A key finding from my thesis is the widespread use of kidney-harming medications in patients with chronic kidney disease (CKD) and the lack of proper monitoring of kidney function, despite clear medical guidelines. Not having a formal CKD diagnosis significantly increases the risk of being prescribed these drugs, highlighting the need for better recognition and documentation of CKD in medical records. Additionally, there is a pressing need to improve how patients on potentially harmful medications are monitored, as current practices are often inadequate.

My research also explores the balance between medication benefits and risks, showing that understanding these trade-offs can help personalize treatment and improve patient safety. For instance, certain newer drugs for CKD appear safer in terms of side effects like high potassium levels, while others may have unexpected risks that warrant closer scrutiny. These findings emphasize the importance of raising awareness among doctors and patients, adhering to treatment guidelines, and refining policies to improve the care and safety of people with CKD.

Why did you become interested in this topic?

I became interested in this topic during my university studies in biostatistics, where the field of epidemiology sparked my fascination. I was eager to explore its real-world implications rather than focusing solely on the methodological aspects. Initially, the specific clinical area was not a priority for me. However, the opportunity to work on my thesis at Karolinska Institutet with Juan Jesus Carreros group introduced me to the kidney field, which gradually caught my attention.

As I continued working in this area, I realized how complex and engaging the kidney field is, offering numerous challenges and opportunities to improve patient outcomes.

This experience allowed me to combine my passion for epidemiology with an appreciation for the clinical aspects of kidney health, making it a deeply fulfilling journey. Looking back, I feel it was a great choice and an area that offers significant opportunities for impactful research.

What do you think should be done in future research?

To improve future health care and research, the gaps identified in this thesis must be addressed. These include enhancing the understanding of medication-related harms, clarifying misconceptions about older therapies, and exploring the benefits and risks of established treatments. Ongoing research should evaluate changes in clinical practices over time to address these gaps and assess their relevance across different health care systems.

Long-term studies are essential to understand the effects of prolonged therapies like lithium on kidney function. Additionally, investigating the reasons behind low therapy persistence, such as with SGLT2-i, and finding ways to improve adherence are critical for ensuring evidence-based care. The hypothesis-generating findings from this thesis, such as potential associations between medications and AKI, highlight the potential of advanced statistical methods in health care research but require further validation before influencing clinical practice.

More information: Alessandro Bosi, Acute and chronic nephrotoxic effects from ambulatory medications (2024). DOI: 10.69622/27160149.v2

Provided by Karolinska Institutet