A systematically collated library of prescribing safety indicators for people with chronic kidney disease

Fiona Smith*, Sam J L Hayward, Barnaby Hole, George J Kimpton, Christine Sluman, Penny F Whiting, Fergus J Caskey

*Corresponding author for this work

Research output: Contribution to journalArticle (Academic Journal)peer-review

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People with chronic kidney disease (CKD) have high levels of co-morbidity and polypharmacy placing them at increased risk of prescribing-related harm. Tools for assessing prescribing safety in the general population using prescribing safety indicators (PSIs) have been established. However, people with CKD pose different prescribing challenges to people without kidney disease. Therefore, PSIs designed for use in the general population may not include all PSIs relevant to a CKD population.

The aim of this study was to systematically collate a library of PSIs relevant to people with CKD.

A systematic literature search identified papers reporting PSIs. CKD-specific PSIs were extracted and categorised by Anatomical Therapeutic Chemical (ATC) classification codes. Duplicate PSIs were removed to create a final list of CKD-specific PSIs.

Nine thousand, eight hundred fifty-two papers were identified by the systematic literature search, of which 511 proceeded to full text screening and 196 papers were identified as reporting PSIs. Following categorisation by ATC code and duplicate removal, 841 unique PSIs formed the final set of CKD-specific PSIs. The five ATC drug classes containing the largest proportion of CKD-specific PSIs were: Cardiovascular system (26%); Nervous system (13.4%); Blood and blood forming organs (12.4%); Alimentary and metabolism (12%); and Anti-infectives for systemic use (11.3%).

CKD-specific PSIs could be used alone or alongside general PSIs to assess the safety and quality of prescribing within a CKD population.
Original languageEnglish
Article number493 (2020)
Number of pages7
JournalBMC Nephrology
Publication statusPublished - 18 Nov 2020


  • chronic kidney disease
  • CKD
  • primary care population
  • outpatient setting
  • prescribing safely
  • potentially inappropriate prescribing
  • prescribing safety indicators


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