Abstract
BackgroundElderly patients with chronic kidney disease (CKD) frequently present comorbidities that put them at risk of polypharmacy and medication-related problems. This study aims to describe the overall medication profile of patients aged ≥75 years with advanced CKD from a multicenter French study and specifically the renally (RIMs) and potentially inappropriate-for-the-elderly medications (PIMs) that they take.MethodsThis is a cross-sectional analysis of medication profiles of individuals aged ≥75 years with eGFR < 20 ml/min/1.73 m2 followed by a nephrologist, who collected their active prescriptions at the study inclusion visit. Medication profiles were first analyzed according to route of administration, therapeutic classification. Second, patients were classified according to their risk of potential medication-related problems, based on whether the prescription was a RIM or a PIM. RIMs and PIMs have been defined according to renal appropriateness guidelines and to Beer’s criteria in the elderly. RIMs were subclassified by 4 types of category: (a) contraindication; (b) dose modification is recommended based on creatinine clearance (CrCl); (c) dose modification based on CrCl is not recommended but a maximum daily dose is mentioned, (d) no specific recommendations based on CrCl: “use with caution”, “avoid in severe impairment”, “careful monitoring of dose is required” “reduce the dose”.ResultsWe collected 5196 individual medication prescriptions for 556 patients, for a median of 9 daily medications [7–11]. Antihypertensive agents, antithrombotics, and antianemics were the classes most frequently prescribed. Moreover, 77.0% of patients had at least 1 medication classified as a RIM. They accounted 31.3% of the drugs prescribed and 9.25% was contraindicated drugs. At least 1 PIM was taken by 57.6 and 45.5% of patients had at least one medication classified as RIM and PIM. The prescriptions most frequently requiring reassessment due to potential adverse effects were for proton pump inhibitors and allopurinol. The PIMs for which deprescription is especially important in this population are rilmenidine, long-term benzodiazepines, and anticholinergic drugs such as hydroxyzine.ConclusionWe showed potential drug-related problems in elderly patients with advanced CKD. Healthcare providers must reassess each medication prescribed for this population, particularly the specific medications identified here.Trial registrationNCT02910908.
Highlights
Patients with chronic kidney disease (CKD) frequently present comorbidities that put them at risk of polypharmacy and medication-related problems
Previous studies have reported that 15–67% of prescriptions for patients with impaired renal function contain errors such as inappropriate doses or intervals, contraindications, or precautions related to renally inappropriate medications (RIMs) [5, 6]
The aim of our study is to describe, first, the overall medication profile of patients ≥75 years with advanced CKD from the multicenter French PSPA study (Parcours de Soin Personnes Agées in French, that is, Care Pathway of the Elderly), and second, which RIMs and Potentially Inappropriate-for-the-elderly Medication (PIM) are used most
Summary
Patients with chronic kidney disease (CKD) frequently present comorbidities that put them at risk of polypharmacy and medication-related problems. Patients with CKD require many prescription medications to slow the progression of their renal disease, control specific complications, and manage frequent comorbidities [2]. Because both the aging process and kidney disease modify the pharmacokinetic and pharmacodynamic profiles of drugs, the overall incidence of ADRs is 3 to 10 times higher in older adults with CKD than in those without it [3]. PIMs are defined as medications that should be generally avoided in people aged ≥75 years because they are either ineffective or at risk of medication-related problems and have a safer alternative [8]
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