W TESFAYE1, RL CASTELINO2, BC WIMMER1, C MCKERCHER3, MD JOSE1,3,4, GM PETERSON1, ST ZAIDI1
1School of Medicine, University of Tasmania, Hobart, Australia, 2The University of Sydney, Sydney, Australia, 3Menzies Institute for Medical Research, Hobart, Australia, 4Renal Unit, Royal Hobart Hospital, Hobart, Australia
Aim: To estimate the prevalence of potentially inappropriate medications (PIMs) use and identify the medications involved, in community-dwelling adults with advanced chronic kidney disease (CKD).
Background: Inappropriate medication use is associated with detrimental clinical outcomes in CKD. However, limited data are available on the level and type of PIMs use in non-institutionalised CKD patients.
Methods: Ninety-three people (67% men) with advanced CKD (estimated glomerular filtration <30ml/min/1.73m2) not receiving dialysis were recruited via treating physicians (general practitioners & nephrologists). PIMs use was evaluated in two ways – (i) Beers criteria and (ii) the Australian Medicines Handbook (AMH) for renally-cleared medications that needed adjustment based on creatinine clearance (CLcr).
Results: The median (interquartile range (IQR)) age of participants was 73 (65-80) years and the majority (76%) were aged (≥65 years). A total of 737 medications, predominantly cardiovascular agents (34%), were prescribed and the mean (SD) number of medications per participant was 8 (3.4). Based on Beers criteria, 17 (24%) of the older participants were exposed to at least one PIM, and clinically important drug interactions were identified in another 10% of them. In contrast, 28 (30%) patients had at least one PIM based on their CLcr (AMH). Prazosin (26%) and benzodiazepines (19%) were the most common PIMs identified using Beers criteria. On the other hand, atenolol (27%) and spironolactone (12%) were frequently identified PIMs per AMH’s dosage recommendations.
Conclusions: The use of PIMs in these patients with advanced CKD is common. While more data are required from large studies on the clinical consequences of PIMs use in these patients, regular medication review using criteria applicable to older adults together with renal dosage adjustment guidelines appears warranted.