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Prevalence of renally inappropriate medicines in older people with renal impairment — A cross‐sectional register‐based study in a large primary care population
Author(s) -
SchmidtMende Katharina,
Wettermark Björn,
Andersen Morten,
Elsevier Monique,
Carrero JuanJesus,
Shemeikka Tero,
Hasselström Jan
Publication year - 2019
Publication title -
basic and clinical pharmacology and toxicology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.805
H-Index - 90
eISSN - 1742-7843
pISSN - 1742-7835
DOI - 10.1111/bcpt.13127
Subject(s) - medicine , renal function , dosing , medical prescription , kidney disease , creatinine , cross sectional study , population , pediatrics , pharmacology , environmental health , pathology
The aim of this population‐based, cross‐sectional study was to analyse the prevalence of renally inappropriate medicines ( RIM s) in older people with renal impairment. We included 30 372 people aged ≥65 years 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. RIM s 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 1 year 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 1 year. 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 RIM s 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 NSAID s and antidiabetics. We conclude that the prevalence of RIM s in older people with renal impairment is considerably high. Still, RIM use may be manageable as only a limited number of RIM s are frequently used.