Arcoraci Vincenzo, Barbieri Maria Antonietta, Rottura Michelangelo, Nobili Alessandro, Natoli Giuseppe, Argano Christiano, Squadrito Giovanni, Squadrito Francesco, Corrao Salvatore
Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy.
Department of Neuroscience, IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy.
Front Pharmacol. 2021 Oct 8;12:749711. doi: 10.3389/fphar.2021.749711. eCollection 2021.
Aging with multimorbidity and polytherapy are the most significant factors that could led to inappropriate prescribing of contraindicated medications in patients with chronic kidney disease (CKD). The aim of this study was to evaluate the prescriptions of contraindicated drugs in older adults in CKD and to identify their associated factors in a hospital context. An observational retrospective study was carried out considering all patients ≥65 years with at least one serum creatinine value recorded into the REPOSI register into 2010-2016 period. The estimated glomerular filtration rate (eGFR) was applied to identify CKD. A descriptive analysis was performed to compare demographic and clinical characteristics; logistic regression models were used to estimate factors of inappropriate and percentage changes of drug use during hospitalization. A total of 4,713 hospitalized patients were recorded, of which 49.8% had an eGFR <60 ml/min/1.73 m; the 21.9% were in treatment with at least one inappropriate drug at the time of hospital admission with a decrease of 3.0% at discharge ( = 0.010). The probability of using at least one contraindicated drug was significantly higher in patients treated with more several drugs (OR 1.21, 95% CI 1.16-1.25, p <0.001) and with CKD end-stages (G4: 16.90, 11.38-25.12, < 0.001; G5: 19.38, 11.51-32.64, < 0.001). Low-dose acetylsalicylic acid was the contraindicated drug mainly used at the time of admission, reducing 1.2% at discharge. An overall increase in therapeutic appropriateness in hospitalized older patients with CKD was observed, despite a small percentage of therapeutic inappropriateness at discharge that underlines the need for a closer collaboration with the pharmacologist to improve the drug management.
衰老合并多种疾病及联合用药是导致慢性肾脏病（CKD）患者禁忌药物处方不当的最重要因素。本研究旨在评估CKD老年患者禁忌药物的处方情况，并在医院环境中确定其相关因素。开展了一项观察性回顾性研究，纳入2010 - 2016年期间REPOSI登记册中记录了至少一次血清肌酐值的所有≥65岁患者。应用估计肾小球滤过率（eGFR）来识别CKD。进行描述性分析以比较人口统计学和临床特征；使用逻辑回归模型估计住院期间药物使用不当的因素及药物使用的百分比变化。共记录了4713例住院患者，其中49.8%的患者eGFR<60 ml/min/1.73 m²；21.9%的患者在入院时至少使用一种不当药物，出院时减少了3.0%（P = 0.010）。使用多种药物治疗的患者（OR 1.21，95%CI 1.16 - 1.25，P<0.001）及CKD终末期患者（G4期：16.90，11.38 - 25.12，P<0.001；G5期：19.38，11.51 - 32.64，P<0.001）使用至少一种禁忌药物的概率显著更高。低剂量阿司匹林是入院时主要使用的禁忌药物，出院时减少了1.2%。观察到住院的CKD老年患者治疗适宜性总体有所提高，尽管出院时有一小部分治疗不当情况，这凸显了与药剂师密切合作以改善药物管理的必要性。
