Department of Health Services Research, Carl von Ossietzky University Oldenburg, Oldenburg, Germany.
Institute for Public Health and Nursing Science, Department for Health Services Research, University of Bremen, Bremen, Germany.
J Am Geriatr Soc. 2017 Apr;65(4):853-862. doi: 10.1111/jgs.14809. Epub 2017 Feb 27.
Renal insufficiency is common among older patients and, accordingly, renally excreted drugs may require an adjustment in dosage for them. Rates of non-adherence to renal dosing guidelines range from 19% to 70% across all settings, with the highest rate occurring in outpatient care. However, there is a paucity of research in this field. The main objective of this systematic review is to assess how often drugs are inappropriately prescribed in non-hospitalized patients with renal insufficiency.
A systematic literature search was performed. Data were identified from three electronic databases: PubMed, CINAHL, and Scopus. Studies were included if they reported quantitative data on inappropriate drug use with respect to renal function in non-hospitalized patients.
Our search strategy resulted in 2,403 hits, of which 18 articles satisfied the criteria for inclusion. Mean estimated glomerular filtration rate ranged from 36.0 to 60.4 mL/min. Prevalence of renally inappropriate drug use ranged from 1% to 37% in outpatient settings other than nursing homes, and from 6% to 43% in nursing homes. Eight of the studies we included identified predictors for use of drugs inappropriate for kidney function. Most frequently determined risk factors were increasing age and a high number of prescribed drugs.
Lack of dose adjustment for renal impairment seems to be a common problem, even in outpatients. However, the differences in methodologies used in these studies hampered any direct comparison. Accepted and comparable standards regarding the drugs included in the studies as well as estimation of renal function would be beneficial.
肾功能不全在老年患者中较为常见，因此，需要根据肾功能调整这些经肾脏排泄的药物剂量。在所有环境中，不遵守肾脏剂量指南的比率从 19%到 70%不等，其中最高的发生率出现在门诊护理中。然而，该领域的研究相对较少。本系统评价的主要目的是评估肾功能不全的非住院患者中，药物的不当处方频率。
进行了系统的文献检索。数据来自三个电子数据库：PubMed、CINAHL 和 Scopus。如果研究报告了非住院患者肾功能与药物使用不当相关的定量数据，则将其纳入。
我们的检索策略共产生了 2403 个结果，其中 18 篇文章符合纳入标准。估计的平均肾小球滤过率范围从 36.0 到 60.4 mL/min。除疗养院以外的门诊环境中，肾不适当用药的发生率从 1%到 37%不等，而疗养院的发生率从 6%到 43%不等。我们纳入的 8 项研究确定了肾功能异常药物使用的预测因素。最常确定的危险因素是年龄增长和开处方药物的数量增加。
即使在门诊患者中，缺乏对肾功能损害的剂量调整似乎也是一个常见问题。然而，这些研究中使用的方法学差异妨碍了任何直接比较。关于研究中包含的药物以及肾功能评估的可接受和可比标准将是有益的。
