Jaffuel Maryline, Gervais Frederic, Vernaudon Julien, Cerfon Marie-Anne, Krolak-Salmon Pierre, Mouchoux Christelle, Novais Teddy
Charpennes Hospital, Pharmaceutical Unit, University Hospital of Lyon, 69100 Villeurbanne, France.
Day-care unit, Charpennes Hospital, University Hospital of Lyon, 69100 Villeurbanne, France.
Nephrol Ther. 2023 Apr 26;19(2):89-98. doi: 10.1684/ndt.2023.6.
Regarding older patients, multiple chronic conditions lead to the intake of multiple medications, involving a higher risk of adverse drug events. In older patients with advanced chronic kidney disease, the medication exposure was poorly explored. The aim of this study was to describe the use of potentially inappropriate medications and medications with anticholinergic and sedative properties in older community-dwelling patients with advanced chronic kidney disease.
An observational study was conducted in a geriatric day-care unit. All patients aged over 65 years with advanced chronic kidney disease, defined by estimated glomerular filtration rate < 20 mL/min/1.73 m2 or estimated glomerular filtration rate > 20 mL/min/1.73 m2 with rapid progression, and referred by nephrologist for pretransplant comprehensive geriatric assessment, were included in the study. Potentially inappropriate medications were identified using the EU(7)-PIM list, and he anticholinergic and sedative drug exposure was measured using the Drug Burden Index.
Overall, 139 patients were included in the study (mean age 74.4 ± 3.3 years, 32.4% females, 61.9% on dialysis). Potentially inappropriate medications were used by 74.1% (103/139) of patients and were mainly represented by proton pump inhibitors, alpha-1-blockers and central antihypertensive drugs. Regarding anticholinergic and / or sedative medications, 79.9% (111/139) of older patients were exposed.
In older community-dwelling patients with advanced chronic kidney disease, the prevalence of potentially inappropriate medication exposure and anticholinergic and sedative exposure was high. Interventions focusing on deprescription of these inappropriate medications should be conducted in this specific population.
对于老年患者而言，多种慢性疾病导致多种药物的摄入，这使得药物不良事件的风险更高。在患有晚期慢性肾脏病的老年患者中，药物暴露情况尚未得到充分研究。本研究的目的是描述在患有晚期慢性肾脏病的社区老年患者中潜在不适当药物以及具有抗胆碱能和镇静特性药物的使用情况。
在一家老年日间护理机构进行了一项观察性研究。所有年龄超过65岁、患有晚期慢性肾脏病（定义为估计肾小球滤过率<20 mL/min/1.73 m² 或估计肾小球滤过率>20 mL/min/1.73 m² 且进展迅速）、由肾病科医生转诊进行移植前综合老年评估的患者均纳入本研究。使用欧盟（7）-PIM清单识别潜在不适当药物，并使用药物负担指数测量抗胆碱能和镇静药物暴露情况。
总体而言，139名患者纳入本研究（平均年龄74.4±3.3岁，女性占32.4%，61.9%接受透析）。74.1%（103/139）的患者使用了潜在不适当药物，主要包括质子泵抑制剂、α-1受体阻滞剂和中枢性抗高血压药物。关于抗胆碱能和/或镇静药物，79.9%（111/139）的老年患者有暴露。
在患有晚期慢性肾脏病的社区老年患者中，潜在不适当药物暴露以及抗胆碱能和镇静药物暴露的患病率较高。应对这一特定人群进行干预，重点是停用这些不适当药物。
