Department of Nephrology, Medical Division, Akershus University Hospital, Lørenskog, Norway.
Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
Eur J Clin Pharmacol. 2019 Nov;75(11):1503-1511. doi: 10.1007/s00228-019-02727-9. Epub 2019 Jul 29.
Polypharmacy and inappropriate prescribing are common in elderly with chronic kidney disease (CKD). This study identified potentially inappropriate prescriptions (PIPs) and potential prescribing omissions (PPOs) using the Screening Tool of Older Persons' Prescriptions (STOPP) and the Screening Tool to Alert doctors to the Right Treatment (START) criteria in elderly with advanced CKD and determined the effect of a medication review on medication adherence and health-related quality of life (HRQoL).
The intervention consisted of a medication review using STOPP/START criteria with a recommendation to a nephrologist or similar review without a recommendation. End points were prevalence of PIP and PPO, medication adherence, and HRQoL. Group differences in outcomes were assessed using a generalized linear mixed model. The trial was registered under www.clinicaltrial.gov (ID: NCT02424786).
We randomized 180 patients with advanced CKD (mean age 77 years, 23% female). The prevalence of PIPs and PPOs in the intervention group was 54% and 50%, respectively. The odds of PPOs were lower in the intervention than the control group (OR 0.42, 95% CI 0.19-0.92, p = 0.032), while there was no intergroup difference in the number of PIPs (OR 0.57, CI 0.27-1.20, p = 0.14). There was no difference in changes in medication adherence or HRQoL from baseline to 6 months between the groups.
The intervention with the STOPP/START criteria identified a high prevalence of inappropriate medications in the elderly with advanced CKD and reduced the number of PPOs. However, there was no detectable impact of the intervention on medication adherence or HRQoL.
在患有慢性肾脏病（CKD）的老年人中，药物的联合应用和不适当的处方开具十分常见。本研究使用老年人用药适宜性筛查工具（STOPP）和恰当药物治疗选择工具（START）标准，确定了患有晚期 CKD 的老年人中潜在不适当处方（PIP）和潜在处方遗漏（PPO）的数量，并确定药物审查对药物依从性和健康相关生活质量（HRQoL）的影响。
干预措施包括使用 STOPP/START 标准进行药物审查，并向肾病医生推荐或不推荐类似的审查。终点是 PIP 和 PPO 的发生率、药物依从性和 HRQoL。使用广义线性混合模型评估组间结局差异。该试验在 www.clinicaltrial.gov（注册号：NCT02424786）上注册。
我们随机分配了 180 名患有晚期 CKD 的患者（平均年龄 77 岁，23%为女性）。干预组的 PIP 和 PPO 发生率分别为 54%和 50%。与对照组相比，干预组的 PPO 发生率较低（比值比 0.42，95%置信区间 0.19-0.92，p=0.032），而两组 PIP 数量无差异（比值比 0.57，95%置信区间 0.27-1.20，p=0.14）。两组在药物依从性或 HRQoL 从基线到 6 个月的变化方面均无差异。
使用 STOPP/START 标准的干预措施确定了患有晚期 CKD 的老年人中存在大量不适当药物，并减少了 PPO 的数量。然而，干预措施对药物依从性或 HRQoL 没有明显影响。
