Academic Primary Health Care Centre, Stockholm County Council, Stockholm, Sweden.
Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Huddinge, Sweden.
Basic Clin Pharmacol Toxicol. 2019 Mar;124(3):256-265. doi: 10.1111/bcpt.13127. Epub 2018 Oct 17.
The aim of this population-based, cross-sectional study was to analyse the prevalence of renally inappropriate medicines (RIMs) in older people with renal impairment. We included 30 372 people aged ≥65 years with chronic kidney disease (CKD) stage 3, and 2161 with stage 4 attending primary care in Stockholm, Sweden. We used data derived from SCREAM, a database linking patient-specific data on demography, morbidity, healthcare consumption and dispensed drugs to creatinine measurements. Estimated glomerular filtration rate was calculated with CKD-EPI based on the first non-hospital serum creatinine in 2010. RIMs were defined as medicines needing dose adjustment or being contra-indicated in CKD stage 3 or 4 with reference to Swedish "Janusmed Drugs and Renal function." Dispensed prescription drugs were analysed during 1 year after creatinine assessment. Drug doses were considered as excessive if their mean volume dispensed per day exceeded the recommended dose. Contra-indicated medicines were regarded as inappropriate if dispensed at least once during 1 year. Excessive dosing was present in 42.5% of older people with CKD stage 3 and in 58.1% with stage 4. The prevalence of contra-indicated medicines was 9.4% and 38.0%, respectively. A limited number of RIMs accounted for the majority of excessive dosing, such as drugs acting on the renin-angiotensin-aldosterone system, betablockers and opioids. Commonly dispensed contra-indicated substances were NSAIDs and antidiabetics. We conclude that the prevalence of RIMs in older people with renal impairment is considerably high. Still, RIM use may be manageable as only a limited number of RIMs are frequently used.
本基于人群的横断面研究旨在分析肾功能不全的老年人群中肾不适当药物（RIM）的流行情况。我们纳入了 30372 名年龄≥65 岁且患有慢性肾脏病（CKD）3 期和 2161 名 4 期的患者，他们在瑞典斯德哥尔摩接受初级保健。我们使用了源自 SCREAM 的数据，该数据库将患者的人口统计学、发病率、医疗保健消费和配药数据与肌酐测量值相关联。根据 2010 年首次非住院血清肌酐，使用 CKD-EPI 计算估算肾小球滤过率。根据瑞典“Janusmed 药品与肾功能”，RIM 被定义为在 CKD 3 或 4 期需要剂量调整或禁忌的药物。在肌酐评估后 1 年内分析配药的处方药。如果每日平均配药量超过推荐剂量，则认为药物剂量过大。如果在 1 年内至少配过一次，则认为禁忌药物不适当。3 期 CKD 老年患者中，药物剂量过大的比例为 42.5%，4 期患者为 58.1%。禁忌药物的患病率分别为 9.4%和 38.0%。少数 RIM 占大部分药物剂量过大的原因，如作用于肾素-血管紧张素-醛固酮系统的药物、β受体阻滞剂和阿片类药物。经常配给的禁忌物质是 NSAIDs 和抗糖尿病药物。我们的结论是，肾功能不全的老年患者中 RIM 的患病率相当高。然而，由于只有少数 RIM 经常使用，因此 RIM 的使用可能是可控的。
