Introduction 5-Amino salicylate (5-ASA) medications may rarely be associated with a significant decline in renal function and interstitial nephritis. The British Society of Gastroenterology guidelines1 advise regular renal function monitoring for patients (pts) taking these drugs. This study assessed whether clinicians were following best practise guidelines.
Methods Using longitudinal community and regional pathology databases for the East Kent population (720 k), our renal unit regularly screens a total population of 300,000 for evidence of renal disease. The data extracted is analysed using the SEIK (System for Early Identification of Kidney disease), an automated computerised system to identify pts requiring intervention for kidney disease. As part of this process, all patients taking 5-ASA medication were identified. The pathology database was studied to identify the pts on treatment who had had renal function tests and could differentiate from results initiated in primary and secondary care. Data analysis can be performed over many years of treatment.
Results 800 adult pts (M : 341, F 459) identified taking 5-ASA therapy (median duration 1.5 years (range 1–24 yr); mean (+/- SD) age 52.7 +/- 16.2 yr (range 18.2–94.4). The mean estimated Glomerular Filtration Rate (eGFR) on commencing 5-ASA therapy was 82 ml/min (range 28 - > 90). Pts with an eGFR < 60 were regarded as having chronic kidney disease (stage 3–5).612 pts received 5-ASA’s for 3 months or more (median 3.2; range 1 – 24 yr) and these were included in the final analysis.
293 (48%) pts had no renal function cheques whilst on treatment. 79 (12%) pts had renal function tests less than once every 4 years and 36 pts once every 2 – 4 yrs. 204 pts had renal function measurements in 50% or more of years of treatment, of whom 116 were checked every year. 72 pts with a baseline eGFR < 60 ml/min were treated with 5-ASA’s for 3 or more months. Of these, 8 had no renal function cheques. The eGFR fell in 24 pts and in 8 by > 2ml/min/yr.
Conclusion The majority of pts receiving 5-ASA compounds do not have regular renal function monitoring. Some are started on treatment with abnormal results at baseline and some with identified kidney disease continued on their 5-ASA’s.
Gastroenterologists are failing to follow best practise guidelines.
Disclosure of Interest None Declared.
Mowat et al. Guidelines for the management of inflammatory bowel disease in adults. Gut 2011; 60 : 571 – 607.
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