Wubshet H Tesfaye1, Barbara C Wimmer1, Gregory M Peterson1,2, Ronald L Castelino3, Matthew D Jose1,4,5, Charlotte McKercher4, Syed Tabish R Zaidi1,6. 1. a Department of Pharmacy, School of Medicine, College of Health and Medicine , University of Tasmania , Tasmania , Australia. 2. b Unit for Medication Outcomes Research and Education , University of Tasmania , Tasmania , Australia. 3. c Sydney Nursing School , The University of Sydney , Sydney , Australia. 4. d Menzies Institute for Medical Research , University of Tasmania , Tasmania , Australia. 5. e Royal Hobart Hospital , Tasmania , Australia. 6. f School of Healthcare , University of Leeds , Leeds , UK.
Abstract
OBJECTIVES: Potentially inappropriate medication (PIM) use is associated with increased morbidity and mortality in chronic kidney disease (CKD). However, there is a paucity of data on how hospitalization affects PIM use in older adults with CKD. Therefore, we aimed to measure the impact of hospitalization on PIM use in older CKD patients, and identify factors predicting PIM use. METHODS: A retrospective cohort study was conducted in older adults (≥65 years) with CKD admitted to an Australian tertiary care hospital over a 6 month period. PIM use was measured, upon admission and at discharge, using the Medication Appropriateness Index (MAI) and Beers criteria (2015 version) for medications recommended to be avoided in older adults and under certain conditions. RESULTS: The median age of the 204 patients was 83 years (interquartile range (IQR): 76-87 years) and most were men (61%). Overall, the level of PIM use (MAI) decreased from admission to discharge (median [IQR]: 6 [3-12] to 5 [2-9]; p < .01]). More than half of the participants (55%) had at least one PIM per Beers criterion on admission, which was reduced by discharge (48%; p < .01). People admitted with a higher number of medications (β 0.72, 95% CI 0.56-0.88) and lower eGFR values (β - 0.11, 95% CI -0.18 to -0.04) had higher MAI scores after adjusting for age, sex and Charlson's comorbidity index. CONCLUSIONS: PIMs were commonly used in older CKD patients. Hospitalization was associated with a reduction in PIM use, but there was considerable scope for improvement in these susceptible individuals.
OBJECTIVES: Potentially inappropriate medication (PIM) use is associated with increased morbidity and mortality in chronic kidney disease (CKD). However, there is a paucity of data on how hospitalization affects PIM use in older adults with CKD. Therefore, we aimed to measure the impact of hospitalization on PIM use in older CKDpatients, and identify factors predicting PIM use. METHODS: A retrospective cohort study was conducted in older adults (≥65 years) with CKD admitted to an Australian tertiary care hospital over a 6 month period. PIM use was measured, upon admission and at discharge, using the Medication Appropriateness Index (MAI) and Beers criteria (2015 version) for medications recommended to be avoided in older adults and under certain conditions. RESULTS: The median age of the 204 patients was 83 years (interquartile range (IQR): 76-87 years) and most were men (61%). Overall, the level of PIM use (MAI) decreased from admission to discharge (median [IQR]: 6 [3-12] to 5 [2-9]; p < .01]). More than half of the participants (55%) had at least one PIM per Beers criterion on admission, which was reduced by discharge (48%; p < .01). People admitted with a higher number of medications (β 0.72, 95% CI 0.56-0.88) and lower eGFR values (β - 0.11, 95% CI -0.18 to -0.04) had higher MAI scores after adjusting for age, sex and Charlson's comorbidity index. CONCLUSIONS: PIMs were commonly used in older CKDpatients. Hospitalization was associated with a reduction in PIM use, but there was considerable scope for improvement in these susceptible individuals.
Authors: Rasheeda K Hall; Jacob B Blumenthal; Rebecca M Doerfler; Jing Chen; Clarissa J Diamantidis; Bernard G Jaar; John W Kusek; Krishna Kallem; Mary B Leonard; Sankar D Navaneethan; Daohang Sha; James H Sondheimer; Lee-Ann Wagner; Wei Yang; Min Zhan; Jeffrey C Fink Journal: Am J Kidney Dis Date: 2021-05-23 Impact factor: 11.072
Authors: Safoura Sheikh Rezaei; Hana Šinkovec; Alexander Schöberl; Christoph Rinner; Georg Heinze; Michael Wolzt; Walter Gall Journal: BMC Geriatr Date: 2021-02-10 Impact factor: 3.921