Abstract
BackgroundNumerous medications should be avoided, or require dose adjustment in subjects with impaired kidney function. We aimed to assess the prevalence of potentially inappropriate use of renal risk drugs in a nation-wide, community-dwelling Polish older adult population.MethodsWe analysed regular intake of 38 medications that should be avoided, requiring dose modification, increase the risk of pre-renal kidney injury, or may cause potassium retention in subjects with moderately to severely impaired renal function in the PolSenior data base (N = 4514, mean age 76 ± 11 yrs). Kidney function was assessed with short Modification of Diet in Renal Disease formula estimated glomerular filtration rate (sMDRD) and Cockcroft-Gault creatinine clearance (CC).ResultsThere were 855 (19%) individuals with sMDRD < 60 ml/min/1.73m2, and 1734 (38%) with CC < 60 ml/min. Among drugs that should be avoided, spironolactone (20.4% of patients as classified by sMDRD and 17.5% by CC), non-steroidal anti-inflammatory drugs (13.4 and 11.3%), hydrochlorothiazide (11.1 and 11.0%), and metformin (6.9 and 8.2%) were most frequently used. The most frequently used drugs requiring dose modification were piracetam (13.9% by sMDRD, and 11.9% by CC), digoxin (8.3 and 8.8%), and gliclazide (6.8 and 5.9%). Classification of a drug use as ‘appropriate’ or ‘inappropriate’ was discordant depending on the method of kidney function assessment (sMDRD or CC) in up to 30%.Subgroups with sMDRD < 60 ml/min/1.73m2 and with CC < 60 ml/min were taking ≥2 drugs increasing the risk of pre-renal kidney injury more frequently than individuals with better kidney function (46.6 vs. 23.1 and 33.0% vs. 24.4%, respectively).There were 24.7% of individuals with sMDRD < 60 ml/min/1.73m2 and 18.0% with CC < 60 ml/min taking 2 or more drugs increasing serum potassium level. The proportion of subjects with hyperkalaemia increased with the number of such drugs.ConclusionsUse of drugs that should be avoided or require dose adjustment due to renal impairment, and potentially inappropriate drug combinations is a common problem in older adults in Poland. Assessment of kidney function with sMDRD may result in overlooking of requirements for dose adjustment formulated based on creatinine clearance.Trial registrationNot applicable.
Highlights
Numerous medications should be avoided, or require dose adjustment in subjects with impaired kidney function
Numerous medications commonly used in the older adults should be avoided in subjects with impaired kidney function because of their nephrotoxic properties, e.g., non-steroidal anti-inflammatory drugs (NSAIDs), angiotensin-converting enzyme inhibitors (ACEI), methotrexate, loop and thiazide diuretics, ranitidine, some antibiotics [8]
We identified individuals taking a combination of two or more drugs increasing the risk of pre-renal impairment of kidney function (Table 4)
Summary
Numerous medications should be avoided, or require dose adjustment in subjects with impaired kidney function. Despite the recognized importance of inappropriate drug prescriptions in older adults with CKD, the appropriate choice of medication and dosage adjustment are often neglected in daily clinical practice. It is caused by utilization of eGFR provided by laboratories along with serum concentration of creatinine, calculated according to the short Modification of Diet in Renal Disease (sMDRD), or the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formulas, and skipping calculation of Cockcroft-Gault creatinine clearance (CC) used in drug registration process and required for dose adjustment
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