Avoidance of polypharmacy and excessive blood pressure control is associated with improved renal function in older patients

Abstract

Background: Elderly patients are particularly susceptible to polypharmacy. The present study evaluated the renal effects of optimizing potentially nephrotoxic medications in an older population. Methods: Retrospective study of patients’ ≥60 years treated between January of 2013 and February of 2015 in a Nephrology Clinic. The renal effect of avoiding polypharmacy was studied. Results: Sixty-one patients were studied. Median age was 81 years (range 60–94). Twenty-five patients (41%) were male. NSAIDs alone were stopped in seven patients (11.4%), a dose reduction in antihypertensives was done in 11 patients (18%), one or more antihypertensives were discontinued in 20 patients (32.7%) and discontinuation and dose reduction of multiple medications was carried out in 23 patients (37.7%). The number of antihypertensives was reduced from a median of 3 (range of 0–8) at baseline to a median of 2 (range 0–7), p < 0.001 after intervention. After intervention, the glomerular filtration rate (GFR) improved significantly, from a baseline of 32 ± 15.5 cc/min/1.73m2 to 39.5 ± 17 cc/min/1.73m2 at t1 (p < 0.001) and 44.5 ± 18.7 cc/min/1.73m2 at t2 (p < 0.001 vs. baseline). In a multivariate model, after adjusting for ACEIs/ARBs discontinuation/dose reduction, NSAIDs use and change in DBP, an increase in SBP at time 1 remained significantly associated with increments in GFR on follow-up (estimate = 0.20, p = 0.01). Conclusions: Avoidance of polypharmacy was associated with an improvement in renal function.