Prescriptions classed as inappropriate on the basis of impaired renal function is prevalent among older people with cognitive impairment and dementia. |
Impaired renal function is common among older people with cognitive impairment and dementia. |
Continuous estimation of renal function is important in this group. |
1 Introduction
2 Methods
2.1 Setting and Study Design
2.2 Data Extraction
Stage | Physiologic change | GFR (ml/min/1.73 m2) |
---|---|---|
– | At increased risk for CKD | ≥90 with risk factors |
1 | CKD with normal or increased kidney function | ≥90 |
2 | CKD with mild impairment of kidney function | 60–89 |
3 | Moderate impairment of kidney function | 30–59 |
4 | Severe impairment of kidney function | 15–29 |
5 | Terminal renal failure | <15 |
2.3 Data Analysis
3 Results
Characteristics of study sample | |
---|---|
Cases (n) | 428 |
Women | 270 (63.1) |
Age (years) | 83.2 ± 6.6 (65–99) |
Weight (kg) | 68.2 ± 15.4 (32.8–130.0) |
BMIa (kg/m2) | 25.1 ± 4.9 (13.3–46.6) |
Number of medications at admission | 7.8 ± 3.5 (0–20) |
Renal function | |
Cs,cr (μmol/L) | 89.0 ± 39.7 (28.0–311.0) |
eGFRCG (ml/min) | 55.3 ± 22.6 (12.8–144.3) |
eGFRCKD-EPI
a (ml/min) | 64.8 ± 22.0 (11.3–126.2) |
eGFRCKD-EPI (ml/min/1.73 m2) | 64.6 ± 21.1 (11.8–115.2) |
MMSEb (0–30) | 19.8 ± 4.6 (7–29) |
Type of dementia | |
Alzheimer’s disease | 131 (30.6) |
Vascular dementia | 72 (16.8) |
Other or UNS dementia | 225 (52.6) |
Living situation | |
Living at home | 304 (71.0) |
Nursing home | 124 (29.0) |
CKD stage | CKD-EPIa
| CKD-EPIb
|
---|---|---|
1 | 56 (13.3) | 42 (9.8) |
2 | 193 (45.7) | 213 (49.8) |
3 | 148 (35.1) | 149 (34.8) |
4 | 23 (5.5) | 23 (5.4) |
5 | 2 (0.5) | 1 (0.2) |
Total | 422 (98.6) | 428 (100) |
Patient characteristics | eGFRCG > 60 ml/min (n = 148) | eGFRCG < 60 ml/min (n = 280) | Simple OR | Multiple OR |
---|---|---|---|---|
Sex | ||||
Men | 71 (48.0) | 87 (31.1) | Reference | |
Women | 77 (52.0) | 193 (68.9) | 2.046 (1.358–3.082) | 1.502 (0.941–2.398) |
Age (years) | 78.9 ± 6.4 | 85.4 ± 5.5 | 1.204 (1.154–1.256) | 1.203 (1.152–1.257) |
Living situation | ||||
Living at home | 105 (70.9) | 199 (71.1) | Reference | |
Nursing home | 43 (29.1) | 81 (28.9) | 0.994 (0.641–1.542) | 0.687 (0.410–1.151) |
MMSE (0–30) | 20.2 ± 5.1 | 19.6 ± 4.3 | 0.970 (0.900–1.046) |
Drug/GDH dosage recommendation | Total prescriptions | Too high dose | Contraindicated prescriptions | Total inappropriate prescriptions |
---|---|---|---|---|
Acamprosate | 1 (0.2) | – | – | – |
CLcr < 30 ml/min: contraindicated | ||||
Acetylsalicylic acid | 152 (27.8) | – | – | – |
CLcr < 10 ml/min: contraindicated | ||||
Alendronate | 15 (2.7) | – | 2 (6.1) | 2 (4.0) |
CLcr < 35 ml/min: contraindicated | ||||
Alfuzosin | 20 (3.7) | – | 1 (3.0) | 1 (2.0) |
CLcr < 30 ml/min: contraindicated | ||||
Allopurinol | 21 (3.8) | 8 (47.1) | – | 8 (16.0) |
CLcr > 140 ml/min: 400 mg/day | ||||
CLcr 121–140 ml/min: 350 mg/day | ||||
CLcr 101–120 ml/min: 300 mg/day | ||||
CLcr 81–100 ml/min: 250 mg/day | ||||
CLcr 61–80 ml/min: 200 mg/day | ||||
CLcr 41–60 ml/min: 150 mg/day | ||||
CLcr 21–40 ml/min: 100 mg/day | ||||
CLcr 11–20 ml/min: 100 mg every 2nd day | ||||
CLcr ≤ 10 ml/min: 100 mg every 3rd day | ||||
Amiloride | 5 (0.9) | – | – | – |
CLcr 10–50 ml/min: 20 mg/day | ||||
CLcr < 10 ml/min: contraindicated | ||||
Amoxicillin | 7 (1.3) | 1 (5.9) | – | 1 (2.0) |
CLcr 10–30 ml/min: 1000 mg/day | ||||
CLcr < 10 ml/min: 500 mg/day | ||||
Ampicillin | 1 (0.2) | 1 (5.9) | – | 1 (2.0) |
CLcr ≥ 10 ml/min: 2000 mg/day | ||||
CLcr < 10 ml/min: 1000 mg/day | ||||
Atenolol | 10 (1.8) | – | – | – |
CLcr 15–35 ml/min: 50 mg/day | ||||
CLcr < 15 ml/min: 50 mg every 2nd day | ||||
Azathioprine | 2 (0.4) | – | – | – |
CLcr 10–50 ml/min: 75 % of 3 mg/kg/day | ||||
CLcr < 10 ml/min: 50 % of 3 mg/kg/day | ||||
Bendroflumethiazide | 19 (3.5) | – | 1 (3.0) | 1 (2.0) |
CLcr < 30 ml/min: contraindicated | ||||
Cefadroxil | 1 (0.2) | – | – | – |
CLcr 10–25 ml/min: 1000 mg/day | ||||
CLcr < 10 ml/min: 1000 mg every 36th h | ||||
Cefotaxime | 9 (1.6) | 1 (5.9) | – | 1 (2.0) |
CLcr 10–30 ml/min: 2000 mg/day | ||||
CLcr < 10 ml/min: 2000 mg every 2nd day | ||||
Cetirizine | 2 (0.4) | 1 (5.9) | – | 1 (2.0) |
CLcr 11–31 ml/min: 5 mg/day | ||||
CLcr < 11 ml/min: contraindicated | ||||
Ciprofloxacin | 4 (0.7) | 1 (5.9) | – | 1 (2.0) |
CLcr 30–50 ml/min: 1000 mg/day | ||||
CLcr 5–29 ml/min: 500 mg every 18th h | ||||
Codeine | 5 (0.9) | – | – | – |
CLcr 10–50 ml/min: ER 450 mg/day, IR 360 mg/day | ||||
CLcr < 10 ml/min: ER 300 mg/day, IR 240 mg/day | ||||
Dabigatran | 2 (0.4) | – | – | – |
CLcr < 30 ml/min: contraindicated | ||||
Diclofenac | 1 (0.2) | – | – | – |
CLcr < 30 ml/min: contraindicated | ||||
Dihydroergotamine | 2 (0.4) | – | – | – |
CLcr ≤ 29 ml/min: contraindicated | ||||
Fesoterodine | 1 (0.2) | – | – | – |
CLcr < 30 ml/min: 4 mg/day | ||||
Fluconazole | 2 (0.4) | – | – | – |
CLcr < 50 ml/min: 400 mg/day | ||||
Fondaparinux | 2 (0.4) | – | – | – |
CLcr < 30 ml/min: contraindicated | ||||
Gabapentin | 12 (2.2) | – | – | – |
CLcr ≥ 60 ml/min: 3600 mg/day | ||||
CLcr 30–59 ml/min: 1400 mg/day | ||||
CLcr 16–29 ml/min: 700 mg/day | ||||
CLcr 15 ml/min: 300 mg/day | ||||
CLcr < 15 ml/min: reduce daily dose (from 300 mg) in proportion to CLcr
| ||||
Galantamine | 28 (5.1) | 1 (5.9) | – | 1 (2.0) |
CLcr 10–59 ml/min: 16 mg/day CLcr < 9 ml/min: contraindicated | ||||
Glibenclamide | 8 (1.5) | – | 2 (6.0) | 2 (4.0) |
CLcr < 50 ml/min: contraindicated | ||||
Glipizide | 7 (1.3) | – | – | – |
CLcr < 10 ml/min: contraindicated | ||||
Hydralazine | 1 (0.2) | – | – | – |
CLcr 10–50 ml/min: 225 mg/day | ||||
Hydrochlorothiazide | 17 (3.1) | – | 2 (6.1) | 2 (4.0) |
CLcr < 30 ml/min: contraindicated | ||||
Ibuprofen | 1 (0.2) | – | – | – |
CLcr < 30 ml/min: contraindicated | ||||
Ketoprofen | 2 (0.4) | 1 (5.9) | – | 1 (2.0) |
CLcr 25–89 ml/min: 150 mg/day | ||||
CLcr < 25 ml/min: 100 mg/day | ||||
Levetiracetam | 2 (0.4) | – | – | – |
CLcr > 80 ml/min: 3000 mg/day | ||||
CLcr 50–80 ml/min: 2000 mg/day | ||||
CLcr 30–49 ml/min: 1500 mg/day | ||||
CLcr < 30 ml/min: 1000 mg/day | ||||
Lithium | 2 (0.4) | – | – | – |
CLcr 10–50 ml/min: 1800 mg/day | ||||
CLcr < 10 ml/min: 1200 mg/day | ||||
Memantine | 25 (4.6) | 2 (11.8) | – | 2 (4.0) |
CLcr 5–29 ml/min: 10 mg/day | ||||
Methenamine | 1 (0.2) | – | – | – |
CLcr < 50 ml/min: contraindicated | ||||
Metformin | 34 (6.2) | – | 12 (36.4) | 12 (24.0) |
CLcr < 60 ml/min: contraindicated | ||||
Methotrexate | 4 (0.7) | – | – | – |
CLcr < 10 ml/min: contraindicated | ||||
Metoclopramide | 3 (0.5) | – | – | – |
CLcr < 40 ml/min: 30 mg/day | ||||
Mirabegron | 3 (0.5) | – | – | – |
CLcr < 15 ml/min: contraindicated | ||||
Morphine | 40 (7.3) | – | 5 (15.2) | 5 (10.0) |
CLcr < 30 ml/min: contraindicated | ||||
Naproxen | 1 (0.2) | – | – | – |
CLcr < 30 ml/min: contraindicated | ||||
Nitrofurantoin | 5 (0.9) | – | 3 (9.1) | 3 (6.0) |
CLcr < 60 ml/min: contraindicated | ||||
Norfloxacin | 1 (0.2) | – | – | – |
CLcr ≤ 30 ml/min: 400 mg/day | ||||
Piperacillin/tazobactam | 1 (0.2) | – | – | – |
CLcr 20–40 ml/min: 8000/1000 mg/day | ||||
CLcr < 20 ml/min: 6000/750 mg/day | ||||
Pramipexole | 3 (0.5) | – | – | – |
ER formulations: | ||||
CLcr 30–50 ml/min: 2.25 mg/day | ||||
CLcr < 30 ml/min: contraindicated | ||||
IR formulations: | ||||
CLcr 30–50 ml/min: 2.25 mg/day | ||||
CLcr 15–29 ml/min: 1.5 mg/day | ||||
CLcr < 15 ml/min: contraindicated | ||||
Pregabalin | 5 (0.9) | – | – | – |
CLcr ≥ 60 ml/min: 600 mg/day | ||||
CLcr 30–59 ml/min: 300 mg/day | ||||
CLcr 15–29 ml/min: 150 mg/day | ||||
CLcr < 15 ml/min: 75 mg/day | ||||
Raloxifene | 1 (0.2) | – | 1 (3.0) | 1 (2.0) |
CLcr < 59 ml/min: contraindicated | ||||
Ranitidine | 1 (0.2) | – | – | – |
CLcr < 50 ml/min: 150 mg/day | ||||
Risedronate | 2 (0.4) | – | – | – |
CLcr < 30 ml/min: contraindicated | ||||
Rosuvastatin | 1 (0.2) | – | – | – |
CLcr < 30 ml/min: 10 mg/day | ||||
Saxagliptin | 1 (0.2) | – | – | – |
CLcr ≤ 50 ml/min: 2.5 mg/day | ||||
Solifenacin | 6 (1.1) | – | – | – |
CLcr < 30 ml/min: 5 mg/day | ||||
Spironolactone | 27 (4.9) | – | 3 (9.1) | 3 (6.0) |
CLcr < 30 ml/min: contraindicated | ||||
Sulfamethoxazole/trimethoprim | 1 (0.2) | – | – | – |
CLcr 15–30 ml/min: 1600/320 mg/day CLcr < 15 ml/min: contraindicated | ||||
Tolterodine | 4 (0.7) | – | – | – |
CLcr 10–30 ml/min: 2 mg/day | ||||
Tramadol | 4 (0.7) | – | 1 (3.0) | 1 (2.0) |
CLcr < 30 ml/min: ER contraindicated, IR 200 mg/day | ||||
Trimethoprim | 1 (0.2) | – | – | – |
CLcr 15–30 ml/min: 100 mg every 18th h | ||||
CLcr < 15 ml/min: 100 mg/day | ||||
Venlafaxine | 5 (0.9) | – | – | – |
CLcr 10–70 ml/min: 168.75 mg | ||||
Zoledronic acid | 3 (0.5) | – | – | – |
CLcr < 30 ml/min: contraindicated | ||||
Total, n (row %) | 547 (100) | 17 (3.1) | 33 (6.0) | 50a (9.1) |
Patient characteristics | Correct prescriptions (n = 282) | Inappropriate prescriptions (n = 44) | Simple OR | Multiple OR |
---|---|---|---|---|
Sex | ||||
Men | 113 (40.1) | 17 (38.6) | Reference | |
Women | 169 (59.9) | 27 (61.4) | 1.062 (0.553–2.038) | 0.933 (0.477–1.826) |
Age (years) | 82.7 ± 6.5 | 84.8 ± 6.6 | 1.051 (0.999–1.105) | 1.044 (0.991–1.100) |
Living situation | ||||
Living at home | 206 (73.0) | 25 (56.8) | Reference | |
Nursing home | 76 (27.0) | 19 (43.2) | 2.060 (1.073–3.954) | 1.889 (0.974–3.663) |
MMSE (0–30) | 19.5 ± 4.4 | 20.8 ± 4.0 | 1.074 (0.955–1.206) |