Medication Burden and Inappropriate Prescription Risk Among Elderly With Advanced Chronic Kidney Disease

Abstract

Background Elderly 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. Methods This is a cross-sectional analysis of medication profiles of individuals aged ≥ 75 years with eGFR < 20 ml/min/1.73m2 followed by a nephrologist, who collected their active prescriptions at the study inclusion visit. Medication profiles were analyzed according to route of administration, therapeutic classification, and their potential inappropriateness for these patients, according to Beers' criteria. Results We 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, 88% of patients had at least 1 medication classified as a RIM, and 21% of those were contraindicated drugs. At least 1 PIM was taken by 68.9%. 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. Conclusion We 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.

Cognitive impairment, perceived medication adherence, and high‐risk medication use in patients with reduced kidney function: A cross‐sectional analysis

“…The total number of medications reported by participants in BRINK was greater than what was reported by participants in the longitudinal ARIC cohort, 20 but similar to other cohorts 35,36 . Our results are consistent with previous analyses showing frequent use of PIMs and high‐risk medications among adults with CKD 20,21,35,37 . Previous studies suggest that polypharmacy and PIM use are associated with adverse events in this population.…”

“…Self‐report instruments are known to be subject to social desirability and recall bias, 32 biases that may be accentuated in the setting of CI. However, all of the studies identified by the 2020 review of medication adherence in CKD used self‐reported medication adherence 21 . Self‐reported medication adherence has been associated with adverse drug events in adults with reduced eGFR.…”

“…The Atherosclerosis Risk in Communities (ARIC) observational cohort study found that participants with eGFR < 30 ml/min/1.73 m 2 took an average of 8.9 medications, compared with an average of 6.1 medications for participants without CKD 20 . These medications may include medications that are potentially inappropriate for older adults; a study in France found that 57.6% of adults aged ≥75 years with very low eGFR were on at least one potentially inappropriate medication (PIM) 21 …”

Breaking the adherence barriers: Strategies to improve treatment adherence in dialysis patients

“…26 A crosssectional study of 556 elderly patients with severe renal failure found that 77% had at least one renally inappropriate medication, and 58% had at least one old-age inappropriate medication. 90 Targeted de-prescribing, which is routinely practiced in geriatric patients, has been successfully trialed as a therapeutic strategy in outpatient hemodialysis patients. 91 Although de-prescribing cannot be considered an adherence intervention, avoidable medications should be promptly discontinued to reduce the risk of adverse events, which can precipitate nonadherence.…”

Role of Pharmacist Interventions in Drug Related Problem among Chronic Kidney Disease Patients

“…Studies show that in-hospital drug related problems are on higher scale in India. 1,2 Statistical reports from studies showed the increased presence of DRP prevalence in medical sectors (45%), in a group of people differentiated by the elderly, poly-pharmacy and multimorbidity. 3 up to 40% of hospital inpatients incurred problems related to drugs, rising as the fourth -sixth main cause of death at the health care level.…”