Potentially inappropriate medications and anticholinergic and sedative burden in older community-dwelling patients with advanced chronic kidney disease

IF 0.7 4区医学 Q4 UROLOGY & NEPHROLOGY

Nephrologie & Therapeutique Pub Date : 2023-04-26 DOI:10.1684/ndt.2023.6

Maryline Jaffuel, Frederic Gervais, Julien Vernaudon, Marie-Anne Cerfon, Pierre Krolak-Salmon, Christelle Mouchoux, Teddy Novais

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Abstract

Objective: Regarding older patients, multiple chronic conditions lead to the intake of multiple medications, involving a higher risk of adverse drug events. In older patients with advanced chronic kidney disease, the medication exposure was poorly explored. The aim of this study was to describe the use of potentially inappropriate medications and medications with anticholinergic and sedative properties in older community-dwelling patients with advanced chronic kidney disease.

Methods: An observational study was conducted in a geriatric day-care unit. All patients aged over 65 years with advanced chronic kidney disease, defined by estimated glomerular filtration rate < 20 mL/min/1.73 m2 or estimated glomerular filtration rate > 20 mL/min/1.73 m2 with rapid progression, and referred by nephrologist for pretransplant comprehensive geriatric assessment, were included in the study. Potentially inappropriate medications were identified using the EU(7)-PIM list, and he anticholinergic and sedative drug exposure was measured using the Drug Burden Index.

Results: Overall, 139 patients were included in the study (mean age 74.4 ± 3.3 years, 32.4% females, 61.9% on dialysis). Potentially inappropriate medications were used by 74.1% (103/139) of patients and were mainly represented by proton pump inhibitors, alpha-1-blockers and central antihypertensive drugs. Regarding anticholinergic and / or sedative medications, 79.9% (111/139) of older patients were exposed.

Conclusion: In older community-dwelling patients with advanced chronic kidney disease, the prevalence of potentially inappropriate medication exposure and anticholinergic and sedative exposure was high. Interventions focusing on deprescription of these inappropriate medications should be conducted in this specific population.

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老年社区居住晚期慢性肾病患者的潜在不适当药物和抗胆碱能及镇静负担

目的:老年患者多重慢性疾病导致服用多种药物，发生药物不良事件的风险较高。在老年晚期慢性肾脏疾病患者中，药物暴露的研究很少。本研究的目的是描述老年社区居住的晚期慢性肾病患者使用可能不适当的药物和具有抗胆碱能和镇静特性的药物。方法:在老年日托病房进行观察性研究。所有年龄在65岁以上、肾小球滤过率< 20ml /min/1.73 m2或肾小球滤过率> 20ml /min/1.73 m2且进展迅速并经肾科医生转诊进行移植前老年综合评估的晚期慢性肾病患者纳入研究。使用EU(7)-PIM清单确定可能不适当的药物，使用药物负担指数测量抗胆碱能和镇静药物暴露。结果:共纳入139例患者(平均年龄74.4±3.3岁，女性32.4%，透析患者61.9%)。74.1%(103/139)的患者使用了可能不适当的药物，主要为质子泵抑制剂、α -1受体阻滞剂和中枢性降压药。关于抗胆碱能和/或镇静药物，79.9%(111/139)的老年患者暴露。结论:在老年社区居住的晚期慢性肾病患者中，潜在不适当的药物暴露和抗胆碱能和镇静暴露的患病率很高。应在这一特定人群中进行干预，重点是取消这些不适当药物的处方。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Nephrologie & Therapeutique 医学-泌尿学与肾脏学

CiteScore

0.80

自引率

14.30%

发文量

485

审稿时长

11.9 weeks

期刊介绍： Organe d''expression de la Société de Néphrologie, de la Société Francophone de Dialyse et de la Société de Néphrologie Pédiatrique, Néphrologie et Thérapeutique a pour vocation de publier des textes en français dans le domaine de la Néphrologie, qu''il s''agisse d''actualisation des connaissances, de recommandations de bonne pratique clinique, de publications originales, ou d''informations sur la vie des trois sociétés fondatrices. La variété des thèmes abordés reflète la richesse de la Néphrologie, qu''il s''agisse d''aspects fondamentaux issus de la physiologie, de l''immunologie, de l''anatomo-pathologie, ou de la génétique, ou de sujets de néphrologie clinique, notamment ceux en rapport avec les thérapeutiques néphrologiques, transplantation, hémodialyse et dialyse péritonéale.