Commentary: Potentially inappropriate medication among older patients with diabetic kidney disease

Abstract

Wang et al. (2020)’s recent report on the burden and morbidity consequences of potentially inappropriate medications (PIMs) in a select cohort of type 2 diabetic mellitus (T2DM) patients was both instructive and an “inflection point” in the characterization of the clinical phenotype of this rising morbidity. They found an overall prevalence of 67.5% of PIMs amongst a randomly selected cohort of n = 186 T2DM patients, with the odds of having a PIM phenotype rising 4-fold amongst those hospitalized with concomitant polypharmacy (American Geriatrics Society, 2019; Wang et al., 2020). This report significantly advances the narrative regarding the evolving relationship between PIMs and polypharmacy. Downstream adverse consequences of polypharmacy are a “legion,” but the most serious of these include PIMs, and bidirectional interactions amongst others (Alves-Conceição et al., 2019). Whilst these relationships have since been extensively studied and reported in the general population (Richardson et al., 2015), there remains a paucity of studies purposefully set out to examine key themes of this relationship in patients with chronic kidney disease (CKD).