Login Register Cart 0
Generic placeholder image

Current Aging Science

Editor-in-Chief

ISSN (Print): 1874-6098
ISSN (Online): 1874-6128

Back
Journal Home About Journal Editorial Board Journal Insight Current Issue Volumes/Issues
Subscribe
Research Article

Chronic Kidney Disease (CKD) - A Brand Ambassador/Alarming Bell for Potentially Inappropriate Medication in Elderly Inpatients

Author(s): Rishabh Sharma*, Parveen Bansal, Manik Chhabra and Malika Arora

Volume 15, Issue 1, 2022

Published on: 19 July, 2021

Page: [59 - 64] Pages: 6

DOI: 10.2174/1874609814666210719113157

Price: $65

Abstract

Background: Since the past decade, prevalence of Potentially Inappropriate Medication (PIM) among elderly inpatients has increased drastically. However, limited data is available on PIM indicators and PIMs use among the elderly in patients suffering from Chronic Kidney Disease (CKD).

Objective: The objective of this study is to determine the prevalence of PIMs in elderly hospitalized patients with CKD.

Methods: A cross-sectional study was carried out on 102 patients in a tertiary care hospital. PIMs were identified using Beers criteria 2019. Chi-square test was used to identify the association between variables and PIMs use.

Results: PIMs, as assessed according to AGS updated Beers criteria 2019 was found to be in more than 68.6% of patients of median age 65 years and 3 diagnoses and 7 days median length of stay. Most of the patients (47.1%) had ≥4 diagnosis. The most common comorbidities in patient were diabetes mellitus (n=54) and hypertension (n=55). Most of the subjects (66.7%) were on polypharmacy (5-9 medications/day) and 25.5% were on a higher level of polypharmacy (>10 medicines/day). Approximately 90% of the patients were having very low CrCl < 21ml/min (calculated with the help of Cockcroft- Gault formula). A significant association between PIM use and an increased number of diagnoses, polypharmacy or high-level polypharmacy, was observed.

Conclusion: The prevalence of PIMs in elderly inpatients suffering from CKD is quite high. The study clearly indicates negligence/ lack of awareness amongst physicians leading to increase in PIM use. Authors propose that the CKD patients should attract special attention of physician and should be treated as brand ambassadors/alarming bell for PIM use.

Keywords: Beers criteria, elderly inpatient, American Geriatric Society, potentially inappropriate medication, comorbidities, chronic kidney disease.

« Previous Next »
Graphical Abstract

[1]
Shrestha LB. Population aging in developing countries. Health Aff (Millwood) 2000; 19(3): 204-12.
[http://dx.doi.org/10.1377/hlthaff.19.3.204] [PMID: 10812800]
[2]
Kafetz K. Renal impairment in the elderly: A review. J R Soc Med 1983; 76(5): 398-401.
[http://dx.doi.org/10.1177/014107688307600514] [PMID: 6191032]
[3]
Wong NA, Jones HW. An analysis of discharge drug prescribing amongst elderly patients with renal impairment. Postgrad Med J 1998; 74(873): 420-2.
[http://dx.doi.org/10.1136/pgmj.74.873.420] [PMID: 9799917]
[4]
Novaes PH, da Cruz DT, Lucchetti ALG, Leite ICG, Lucchetti G. The “iatrogenic triad”: Polypharmacy, drug-drug interactions, and potentially inappropriate medications in older adults. Int J Clin Pharm 2017; 39(4): 818-25.
[http://dx.doi.org/10.1007/s11096-017-0470-2] [PMID: 28455830]
[5]
Ramaswamy R, Maio V, Diamond JJ, et al. Potentially inappropriate prescribing in elderly: Assessing doctor knowledge, confidence and barriers. J Eval Clin Pract 2011; 17(6): 1153-9.
[http://dx.doi.org/10.1111/j.1365-2753.2010.01494.x] [PMID: 20630004]
[6]
Charlesworth CJ, Smit E, Lee DS, Alramadhan F, Odden MC. Polypharmacy among adults aged 65 years and older in the United States: 1988–2010. J Gerontol A Biol Sci Med Sci 2015; 70(8): 989-95.
[http://dx.doi.org/10.1093/gerona/glv013] [PMID: 25733718]
[7]
Williams ME. Diabetic kidney disease in elderly individuals. Med Clin North Am 2013; 97(1): 75-89.
[http://dx.doi.org/10.1016/j.mcna.2012.10.011] [PMID: 23290731]
[8]
Health Do. Medicines and older people.Implementing medicines-related aspects of the nsf for older people Department of Health London. 2001.
[9]
Harugeri A, Joseph J, Parthasarathi G, Ramesh M, Guido S. Prescribing patterns and predictors of high-level polypharmacy in the elderly population: A prospective surveillance study from two teaChing hospitals in India. Am J Geriatr Pharmacother 2010; 8(3): 271-80.
[http://dx.doi.org/10.1016/j.amjopharm.2010.06.004] [PMID: 20624616]
[10]
Smits KP, Sidorenkov G, Bilo HJ, et al. Development and initial validation of prescribing quality indicators for patients with chronic kidney disease. Nephrol Dial Transplant 2016; 31(11): 1876-86.
[http://dx.doi.org/10.1093/ndt/gfv420] [PMID: 26743176]
[11]
van der Hooft CS, Jong GW, Dieleman JP, et al. Inappropriate drug prescribing in older adults: The updated 2002 Beers criteria--a population-based cohort study. Br J Clin Pharmacol 2005; 60(2): 137-44.
[http://dx.doi.org/10.1111/j.1365-2125.2005.02391.x] [PMID: 16042666]
[12]
Beers MH, Ouslander JG, Rollingher I, Reuben DB, Brooks J, Beck JC. Explicit criteria for determining inappropriate medication use in nursing home residents. Arch Intern Med 1991; 151(9): 1825-32.
[http://dx.doi.org/10.1001/arChinte.1991.00400090107019] [PMID: 1888249]
[13]
Zhang X, Zhou S, Pan K, et al. Potentially inappropriate medications in hospitalized older patients: A cross-sectional study using the Beers 2015 criteria versus the 2012 criteria. Clin Interv Aging 2017; 12: 1697-703.
[http://dx.doi.org/10.2147/CIA.S146009] [PMID: 29066875]
[14]
Burkhardt H, Bojarsky G, Gretz N, Gladisch R. Creatinine clearance, Cockcroft-Gault formula and cystatin C: Estimators of true glomerular filtration rate in the elderly? Gerontology 2002; 48(3): 140-6.
[http://dx.doi.org/10.1159/000052832] [PMID: 11961366]
[15]
Cor I. IBM SPSS Statistics for Windows, version 240 Armonk, NY: IBM Corp. 2016.
[16]
Vishwas HN, Harugeri A, Parthasarathi G, Ramesh M. Potentially inappropriate medication use in Indian elderly: Comparison of Beers’ criteria and Screening Tool of Older Persons’ potentially inappropriate Prescriptions. Geriatr Gerontol Int 2012; 12(3): 506-14.
[http://dx.doi.org/10.1111/j.1447-0594.2011.00806.x] [PMID: 22239067]
[17]
Undela K, Bansal D, D’Cruz S, Sachdev A, Tiwari P. Prevalence and determinants of use of potentially inappropriate medications in elderly inpatients: A prospective study in a tertiary healthcare setting. Geriatr Gerontol Int 2014; 14(2): 251-8.
[http://dx.doi.org/10.1111/ggi.12081] [PMID: 23647581]
[18]
Jones SA, Bhandari S. The prevalence of potentially inappropriate medication prescribing in elderly patients with chronic kidney disease. Postgrad Med J 2013; 89(1051): 247-50.
[http://dx.doi.org/10.1136/postgradmedj-2012-130889] [PMID: 23417370]
[19]
Hosia-Randell HM, Muurinen SM, Pitkälä KH. Exposure to potentially inappropriate drugs and drug-drug interactions in elderly nursing home residents in Helsinki, Finland: A cross-sectional study. Drugs Aging 2008; 25(8): 683-92.
[http://dx.doi.org/10.2165/00002512-200825080-00005] [PMID: 18665660]
[20]
Varallo FR, Capucho HC, Planeta CdS, Mastroianni PdC. Safety assessment of potentially inappropriate medications (PIM) use in older people and the factors associated with hospital admission. J Pharm Pharm Sci 2011; 283-90.
[http://dx.doi.org/10.18433/J3P01J] [PMID: 21733416]
[21]
Cockcroft DW, Gault MH. Prediction of creatinine clearance from serum creatinine. Nephron 1976; 16(1): 31-41.
[http://dx.doi.org/10.1159/000180580] [PMID: 1244564]
[22]
Levey AS, Bosch JP, Lewis JB, Greene T, Rogers N, Roth D. A more accurate method to estimate glomerular filtration rate from serum creatinine: A new prediction equation. Ann Intern Med 1999; 130(6): 461-70.
[http://dx.doi.org/10.7326/0003-4819-130-6-199903160-00002] [PMID: 10075613]

Rights & Permissions Print Cite
Article Metrics
21
3
© 2024 Bentham Science Publishers | Privacy Policy