Prevalence of renally inappropriate medicines in older people with renal impairment — A cross‐sectional register‐based study in a large primary care population

Abstract

The aim of this population-based, cross-sectional study was to analyse the prevalence of renally inappropriate medicines (RIMs) in older people with renal impairment. We included 30372 people aged ≥65years with chronic kidney disease (CKD) stage 3, and 2161 with stage 4 attending primary care in Stockholm, Sweden. We used data derived from SCREAM, a database linking patient-specific data on demography, morbidity, healthcare consumption and dispensed drugs to creatinine measurements. Estimated glomerular filtration rate was calculated with CKD-EPI based on the first non-hospital serum creatinine in 2010. RIMs were defined as medicines needing dose adjustment or being contra-indicated in CKD stage 3 or 4 with reference to Swedish "Janusmed Drugs and Renal function." Dispensed prescription drugs were analysed during 1year after creatinine assessment. Drug doses were considered as excessive if their mean volume dispensed per day exceeded the recommended dose. Contra-indicated medicines were regarded as inappropriate if dispensed at least once during 1year. Excessive dosing was present in 42.5% of older people with CKD stage 3 and in 58.1% with stage 4. The prevalence of contra-indicated medicines was 9.4% and 38.0%, respectively. A limited number of RIMs accounted for the majority of excessive dosing, such as drugs acting on the renin-angiotensin-aldosterone system, betablockers and opioids. Commonly dispensed contra-indicated substances were NSAIDs and antidiabetics. We conclude that the prevalence of RIMs in older people with renal impairment is considerably high. Still, RIM use may be manageable as only a limited number of RIMs are frequently used.