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The assessment of renal function in relation to the use of drugs in elderly in nursing homes; a cohort study.

Modig, Sara LU ; Lannering, Christina; Östgren, Carl Johan; Mölstad, Sigvard and Midlöv, Patrik LU (2011) In BMC Geriatrics 11.
Abstract
ABSTRACT:

BACKGROUND: Renal function decreases with age. Dosage adjustment according to renal function is indicated for many drugs, in order to avoid adverse reactions of medications and/or aggravation of renal impairment. There are several ways to assess renal function in the elderly, but no way is ideal. The aim of the study was to explore renal function in elderly subjects in nursing homes and the use of pharmaceuticals that may be harmful to patients with renal impairment.



METHODS: 243 elderly subjects living in nursing homes were included. S-creatinine and s-cystatin c were analysed. Renal function was estimated using Cockcroft-Gault formula, Modification of Diet in Renal Disease (MDRD) and cystatin... (More)
ABSTRACT:

BACKGROUND: Renal function decreases with age. Dosage adjustment according to renal function is indicated for many drugs, in order to avoid adverse reactions of medications and/or aggravation of renal impairment. There are several ways to assess renal function in the elderly, but no way is ideal. The aim of the study was to explore renal function in elderly subjects in nursing homes and the use of pharmaceuticals that may be harmful to patients with renal impairment.



METHODS: 243 elderly subjects living in nursing homes were included. S-creatinine and s-cystatin c were analysed. Renal function was estimated using Cockcroft-Gault formula, Modification of Diet in Renal Disease (MDRD) and cystatin C-estimated glomerular filtration rate (GFR). Concomitant medication was registered and four groups of renal risk drugs were identified: metformin, nonsteroidal anti-inflammatory drugs (NSAID), angiotensin-converting enzyme -inhibitors/angiotensin receptor blockers and digoxin. Descriptive statistics and the Kappa test for concordance were used.



RESULTS: Reduced renal function (cystatin C-estimated GFR < 60 ml/min) was seen in 53%. Normal s-creatinine was seen in 41% of those with renal impairment. Renal risk drugs were rather rarely prescribed, with exception for ACE-inhibitors. Poor concordance was seen between the GFR estimates as concluded by other studies.



CONCLUSIONS: The physician has to be observant on renal function when prescribing medications to the elderly patient and not only rely on s-creatinine level. GFR has to be estimated before prescribing renal risk drugs, but using different estimates may give divergence in the results. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
BMC Geriatrics
volume
11
publisher
BioMed Central
external identifiers
  • PMID:21223578
  • Scopus:78651077226
ISSN
1471-2318
DOI
10.1186/1471-2318-11-1
language
English
LU publication?
yes
id
77c63467-97e0-45c8-8672-f1921feead0b (old id 1777588)
alternative location
http://www.ncbi.nlm.nih.gov/pubmed/21223578?dopt=Abstract
date added to LUP
2011-02-01 12:16:44
date last changed
2016-10-13 04:32:44
@misc{77c63467-97e0-45c8-8672-f1921feead0b,
  abstract     = {ABSTRACT:<br/><br>
BACKGROUND: Renal function decreases with age. Dosage adjustment according to renal function is indicated for many drugs, in order to avoid adverse reactions of medications and/or aggravation of renal impairment. There are several ways to assess renal function in the elderly, but no way is ideal. The aim of the study was to explore renal function in elderly subjects in nursing homes and the use of pharmaceuticals that may be harmful to patients with renal impairment.<br/><br>
<br/><br>
METHODS: 243 elderly subjects living in nursing homes were included. S-creatinine and s-cystatin c were analysed. Renal function was estimated using Cockcroft-Gault formula, Modification of Diet in Renal Disease (MDRD) and cystatin C-estimated glomerular filtration rate (GFR). Concomitant medication was registered and four groups of renal risk drugs were identified: metformin, nonsteroidal anti-inflammatory drugs (NSAID), angiotensin-converting enzyme -inhibitors/angiotensin receptor blockers and digoxin. Descriptive statistics and the Kappa test for concordance were used.<br/><br>
<br/><br>
RESULTS: Reduced renal function (cystatin C-estimated GFR &lt; 60 ml/min) was seen in 53%. Normal s-creatinine was seen in 41% of those with renal impairment. Renal risk drugs were rather rarely prescribed, with exception for ACE-inhibitors. Poor concordance was seen between the GFR estimates as concluded by other studies.<br/><br>
<br/><br>
CONCLUSIONS: The physician has to be observant on renal function when prescribing medications to the elderly patient and not only rely on s-creatinine level. GFR has to be estimated before prescribing renal risk drugs, but using different estimates may give divergence in the results.},
  author       = {Modig, Sara and Lannering, Christina and Östgren, Carl Johan and Mölstad, Sigvard and Midlöv, Patrik},
  issn         = {1471-2318},
  language     = {eng},
  publisher    = {ARRAY(0xa5cd808)},
  series       = {BMC Geriatrics},
  title        = {The assessment of renal function in relation to the use of drugs in elderly in nursing homes; a cohort study.},
  url          = {http://dx.doi.org/10.1186/1471-2318-11-1},
  volume       = {11},
  year         = {2011},
}