Self-Reported Medication Use and Urinary Drug Metabolites in the German Chronic Kidney Disease (GCKD) Study

Kotsis F, Schultheiss UT, Wuttke M, Schlosser P, Mielke J, Becker MS, Oefner PJ, Karoly ED, Mohney RP, Eckardt KU, Sekula P, Köttgen A (2021)

Publication Type: Journal article

Publication year: 2021

Journal

Journal of the American Society of Nephrology American Society of Nephrology

Book Volume: 32

Pages Range: 2315-2329

Journal Issue: 9

DOI: 10.1681/ASN.2021010063

Abstract

Background Polypharmacy is common among patients with CKD, but little is known about the urinary excretion of many drugs and their metabolites among patients with CKD. Methods Toevaluate self-reportedmedicationuse in relation tourine drugmetabolite levels in a largecohort of patients with CKD, the German Chronic Kidney Disease study, we ascertained self-reported use of 158 substances and41medication groups, andcodedactive ingredients accordingto theAnatomicalTherapeutic Chemical Classification System. We used a nontargeted mass spectrometry-based approach to quantify metabolites in urine; calculated specificity, sensitivity, and accuracy of medication use and corresponding metabolite measurements; and used multivariable regression models to evaluate associations and prescription patterns. Results Among 4885 participants, therewere 108medication-drugmetabolite pairs on the basis of reported medication use and 78 drug metabolites. Accuracy was excellent for measurements of 36 individual substances inwhich the unchanged drugwasmeasured in urine (median, 98.5%; range, 61.1%-100%). For 66 pairs of substances andtheir relateddrugmetabolites,medianmeasurement-basedspecificity and sensitivity were 99.2% (range, 84.0%-100%) and 71.7% (range, 1.2%-100%), respectively. Commonly prescribed medications for hypertension and cardiovascular risk reduction-including angiotensin II receptor blockers, calcium channel blockers, and metoprolol-showed high sensitivity and specificity. Although self-reported use of prescribed analgesics (acetaminophen, ibuprofen) was <3% each, drug metabolite levels indicated higher usage (acetaminophen, 10%-26%; ibuprofen, 10%-18%). Conclusions This comprehensive screen of associations between urine drug metabolite levels and selfreported medication use supports the use of pharmacometabolomics to assess medication adherence and prescription patterns in persons with CKD, and indicates under-reported use of medications available over the counter, such as analgesics.

Authors with CRIS profile

Kai-Uwe Eckardt Department of Medicine 4 – Nephrology and Hypertension

Involved external institutions

Albert-Ludwigs-Universität Freiburg DE Germany (DE) Metabolon, Inc. US United States (USA) (US) Bayer AG DE Germany (DE) Universität Regensburg DE Germany (DE)

How to cite

APA:

Kotsis, F., Schultheiss, U.T., Wuttke, M., Schlosser, P., Mielke, J., Becker, M.S.,... Köttgen, A. (2021). Self-Reported Medication Use and Urinary Drug Metabolites in the German Chronic Kidney Disease (GCKD) Study. Journal of the American Society of Nephrology, 32(9), 2315-2329. https://doi.org/10.1681/ASN.2021010063

MLA:

Kotsis, Fruzsina, et al. "Self-Reported Medication Use and Urinary Drug Metabolites in the German Chronic Kidney Disease (GCKD) Study." Journal of the American Society of Nephrology 32.9 (2021): 2315-2329.

BibTeX: Download