Khanal Aarati, Peterson Gregory M, Castelino Ronald L, Jose Matthew D
Unit for Medication Outcomes Research and Education, University of Tasmania, Hobart, TAS, Australia,
Drugs Aging. 2015 May;32(5):391-400. doi: 10.1007/s40266-015-0261-1.
Limited data are available on the prevalence of inappropriate prescribing of renally cleared drugs in elderly patients in Australia.
To quantify and compare the extent of inappropriate prescribing (defined as at least one drug prescribed in an excessive dose or when contraindicated with respect to renal function) of renally cleared drugs in elderly patients across the community and aged care settings, and to determine factors associated with patients being prescribed one or more potentially inappropriate renally cleared drugs.
This retrospective study examined de-identified Home Medicines Review (HMR) and Residential Medication Management Review (RMMR) cases pertaining to 30,898 patients aged 65 years and over. Only 25 % (n = 7625) of these patients had documented information on their renal function. Among them, 4035 patients were prescribed at least one of the 31 renally cleared drugs examined in this study. For these patients, details including demographics, medications, medical conditions and pathology test results were extracted. Creatinine clearance was estimated using the Cockcroft-Gault formula, and the prevalence of inappropriate prescribing of the 31 drugs was examined on the basis of conformity with the recommendations in the Australian Medicines Handbook. Multivariate logistic regression was performed to determine the factors associated with patients being prescribed one or more potentially inappropriate renally cleared drugs.
The mean (± standard deviation) ages of the HMR patients (n = 3315; 59 % female) and RMMR patients (n = 720; 68 % female) were 78.3 ± 7.2 and 86 ± 7.3 years, respectively. Over one quarter of the patients (n = 1135 out of 4035; 28.1 %) prescribed the renally cleared drugs examined in this study had evidence of inappropriate prescribing of at least one of the drugs, with respect to their renal function. The drugs/drug classes most commonly prescribed inappropriately were perindopril, fenofibrate, glibenclamide, gliptins, metformin, olmesartan, bisphosphonates and strontium. The factors independently associated with patients being prescribed one or more potentially inappropriate renally cleared drugs were advancing age [odds ratio (OR) 1.06 per year increase, 95 % confidence interval (CI) 1.05-1.07; P < 0.001], the total number of renally cleared drugs prescribed (OR 1.44 per unit increase, 95 % CI 1.29-1.61; P < 0.001), presence of diabetes (OR 1.51, 95 % CI 1.30-1.76; P < 0.001), presence of heart failure (OR 1.38, 95 % CI 1.13-1.69; P < 0.005) and living in aged care facilities (OR 1.28, 95 % CI 1.06-1.5; P < 0.05).
Inappropriate prescribing of renally cleared drugs is common in older Australians. Intervention studies to improve prescribing of renally cleared drugs in the elderly appear to be warranted.
关于澳大利亚老年患者肾清除药物处方不当的患病率，现有数据有限。
量化并比较社区和老年护理机构中老年患者肾清除药物处方不当（定义为至少有一种药物剂量过大或在肾功能禁忌时开具）的程度，并确定与患者开具一种或多种潜在不适当肾清除药物相关的因素。
这项回顾性研究检查了30898名65岁及以上患者的匿名家庭药物审查（HMR）和住院药物管理审查（RMMR）病例。这些患者中只有25%（n = 7625）有肾功能记录信息。其中，4035名患者至少开具了本研究中检查的31种肾清除药物中的一种。对于这些患者，提取了包括人口统计学、药物、医疗状况和病理检查结果等详细信息。使用Cockcroft-Gault公式估算肌酐清除率，并根据是否符合《澳大利亚药物手册》中的建议检查31种药物处方不当的患病率。进行多变量逻辑回归以确定与患者开具一种或多种潜在不适当肾清除药物相关的因素。
HMR患者（n = 3315；59%为女性）和RMMR患者（n = 720；68%为女性）的平均（±标准差）年龄分别为78.3±7.2岁和86±7.3岁。在本研究中开具肾清除药物的患者中，超过四分之一（4035名患者中的1135名；28.1%）有证据表明至少有一种药物在肾功能方面处方不当。最常被不当处方的药物/药物类别是培哚普利、非诺贝特、格列本脲、格列汀类、二甲双胍、奥美沙坦、双膦酸盐和锶。与患者开具一种或多种潜在不适当肾清除药物独立相关的因素是年龄增长[每年增加的优势比（OR）为1.06，95%置信区间（CI）为1.05 - 1.07；P < 0.001]、开具的肾清除药物总数（每增加一个单位OR为1.44，95%CI为1.29 - 1.61；P < 0.001）、糖尿病的存在（OR为1.51，95%CI为1.30 - 1.76；P < 0.001）、心力衰竭的存在（OR为1.38，95%CI为1.13 - 1.69；P < 0.005）以及居住在老年护理机构（OR为1.28，95%CI为1.06 - 1.5；P < 0.05）。
肾清除药物处方不当在澳大利亚老年人中很常见。开展干预研究以改善老年人肾清除药物的处方似乎很有必要。
