Chair and Department of Palliative Medicine, Poznan University of Medical Sciences, Hospicjum Palium, os. Rusa 55, 61-245, Poznan, Poland.
Palliative Medicine Unit, University Hospital of Lord's Transfiguration, Poznan, Poland.
BMC Geriatr. 2019 Mar 5;19(1):70. doi: 10.1186/s12877-019-1075-5.
Numerous medications should be avoided, or require dose adjustment in subjects with impaired kidney function. We aimed to assess the prevalence of potentially inappropriate use of renal risk drugs in a nation-wide, community-dwelling Polish older adult population.
We analysed regular intake of 38 medications that should be avoided, requiring dose modification, increase the risk of pre-renal kidney injury, or may cause potassium retention in subjects with moderately to severely impaired renal function in the PolSenior data base (N = 4514, mean age 76 ± 11 yrs). Kidney function was assessed with short Modification of Diet in Renal Disease formula estimated glomerular filtration rate (sMDRD) and Cockcroft-Gault creatinine clearance (CC).
There were 855 (19%) individuals with sMDRD < 60 ml/min/1.73m, and 1734 (38%) with CC < 60 ml/min. Among drugs that should be avoided, spironolactone (20.4% of patients as classified by sMDRD and 17.5% by CC), non-steroidal anti-inflammatory drugs (13.4 and 11.3%), hydrochlorothiazide (11.1 and 11.0%), and metformin (6.9 and 8.2%) were most frequently used. The most frequently used drugs requiring dose modification were piracetam (13.9% by sMDRD, and 11.9% by CC), digoxin (8.3 and 8.8%), and gliclazide (6.8 and 5.9%). Classification of a drug use as 'appropriate' or 'inappropriate' was discordant depending on the method of kidney function assessment (sMDRD or CC) in up to 30%. Subgroups with sMDRD < 60 ml/min/1.73m and with CC < 60 ml/min were taking ≥2 drugs increasing the risk of pre-renal kidney injury more frequently than individuals with better kidney function (46.6 vs. 23.1 and 33.0% vs. 24.4%, respectively). There were 24.7% of individuals with sMDRD < 60 ml/min/1.73m and 18.0% with CC < 60 ml/min taking 2 or more drugs increasing serum potassium level. The proportion of subjects with hyperkalaemia increased with the number of such drugs.
Use of drugs that should be avoided or require dose adjustment due to renal impairment, and potentially inappropriate drug combinations is a common problem in older adults in Poland. Assessment of kidney function with sMDRD may result in overlooking of requirements for dose adjustment formulated based on creatinine clearance.
Not applicable.
许多药物应避免使用，或需要根据肾功能受损的程度调整剂量。我们旨在评估在波兰全国范围内的社区居住的老年人群中，潜在不适当使用肾脏风险药物的情况。
我们分析了在 PolSenior 数据库（N=4514 名，平均年龄 76±11 岁）中，38 种应避免使用、需要调整剂量、增加潜在肾前肾损伤风险或可能导致钾潴留的药物在肾功能中度至重度受损的患者中的常规摄入情况。用简化肾脏病饮食改良公式估计肾小球滤过率（sMDRD）和 Cockcroft-Gault 肌酐清除率（CC）评估肾功能。
有 855 名患者（sMDRD<60ml/min/1.73m 患者的 19%）和 1734 名患者（CC<60ml/min 患者的 38%）的 sMDRD 降低。在需要避免使用的药物中，螺内酯（按 sMDRD 分类的患者为 20.4%，按 CC 分类的患者为 17.5%）、非甾体抗炎药（13.4%和 11.3%）、氢氯噻嗪（11.1%和 11.0%）和二甲双胍（6.9%和 8.2%）是最常用的药物。需要调整剂量的最常用药物是吡拉西坦（按 sMDRD 分类的患者为 13.9%，按 CC 分类的患者为 11.9%）、地高辛（8.3%和 8.8%）和格列齐特（6.8%和 5.9%）。根据肾功能评估方法（sMDRD 或 CC）的不同，药物使用的分类为“适当”或“不适当”，结果可能不一致，差异可达 30%。sMDRD<60ml/min/1.73m 和 CC<60ml/min 的亚组比肾功能较好的患者更常服用两种或更多种增加潜在肾前肾损伤风险的药物（分别为 46.6%比 23.1%和 33.0%比 24.4%）。sMDRD<60ml/min/1.73m 的患者中有 24.7%和 CC<60ml/min 的患者中有 18.0%服用了两种或更多种增加血清钾水平的药物。高钾血症患者的比例随着此类药物的数量而增加。
在波兰，老年人群中存在因肾功能损害而应避免使用或需要调整剂量的药物，以及潜在不适当的药物联合使用的问题较为常见。使用 sMDRD 评估肾功能可能会忽略根据肌酐清除率制定的剂量调整要求。
不适用。
