Medication burden and inappropriate prescription risk among elderly with advanced chronic kidney disease

Clarisse Roux-Marson (1, 2) , Jean Baptiste Baranski (2) , Coraline Fafin (2) , Guillaume Exterman (3) , Cécile Vigneau (4, 5) , Cécile Couchoud (6) , Olivier Moranne (1, 2)

1 AIDMP - Aide à la Décision pour une Médecine Personnalisé - Laboratoire de Biostatistique, Epidémiologie et Recherche Clinique - EA 2415
2 CHU Nîmes - Centre Hospitalier Universitaire de Nîmes
3 Cabinet Médecine généraliste [Nice]
4 Centre Hospitalier Universitaire de Rennes [CHU Rennes] = Rennes University Hospital [Ponchaillou]
5 Irset - Institut de recherche en santé, environnement et travail
6 LBBE - Laboratoire de Biométrie et Biologie Evolutive - UMR 5558

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/1.73 m2 followed by a nephrologist, who collected their active prescriptions at the study inclusion visit. Medication profiles were first analyzed according to route of administration, therapeutic classification. Second, patients were classified according to their risk of potential medication-related problems, based on whether the prescription was a RIM or a PIM. RIMs and PIMs have been defined according to renal appropriateness guidelines and to Beer’s criteria in the elderly. RIMs were subclassified by 4 types of category: (a) contraindication; (b) dose modification is recommended based on creatinine clearance (CrCl); (c) dose modification based on CrCl is not recommended but a maximum daily dose is mentioned, (d) no specific recommendations based on CrCl: “use with caution”, “avoid in severe impairment”, “careful monitoring of dose is required” “reduce the dose”.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, 77.0% of patients had at least 1 medication classified as a RIM. They accounted 31.3% of the drugs prescribed and 9.25% was contraindicated drugs. At least 1 PIM was taken by 57.6 and 45.5% of patients had at least one medication classified as RIM and PIM. 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.

Mots clés: Polypharmacy; Chronic kidney disease; Elderly; Medication prescription

Domaines: Urologie et Néphrologie; Gériatrie et gérontologie; Pharmacologie

Clarisse Roux-Marson, Jean Baptiste Baranski, Coraline Fafin, Guillaume Exterman, Cécile Vigneau, et al.. Medication burden and inappropriate prescription risk among elderly with advanced chronic kidney disease. BMC Geriatrics, 2020, 20 (1), pp.87. ⟨10.1186/s12877-020-1485-4⟩. ⟨hal-02565462⟩