BACKGROUND / OBJECTIVES Little is known about how many ambulatory older adults with chronic kidney disease receive medications that are contraindicated or dosed excessively given their level of renal function. DESIGN, SETTING, AND PARTICIPANTS Cross-sectional retrospective study of adults age 65 and older with creatinine clearance (CrCl) 15–49 ml/min who received care in U.S. Department of Veterans Affairs (VA) clinics. MEASUREMENTS We examined 39 medications which require dose adjustment or are contraindicated in people with impaired renal function. Medication use and CrCl (calculated using the Cockroft-Gault equation) were assessed through VA pharmacy, laboratory, and other data sources as of October 2007. RESULTS Among 83,850 eligible older veterans with CrCl 15–49 ml/min, mean age was 80 years and 96% were men. Overall, 13% of patients with CrCl 30–49 ml/min and 29% of patients with CrCl 15–29 ml/min received one or more drugs that were contraindicated or prescribed at an excessive dose given the patient’s level of renal function. The strongest risk factor for renally inappropriate prescribing was number of medications used: the adjusted relative risk of receiving renally inappropriate medications was 5.6 times higher (95% CI, 5.2–6.0) in older adults taking 10 or more medications compared with those taking 1–3 medications. Ranitidine, allopurinol, and metformin together accounted for 76% of renally misprescribed medications in patients with CrCl 30–49 ml/min. Glyburide, ranitidine, gemfibrozil, and allopurinol accounted for 42% of renally misprescribed drugs for patients with CrCl 15–29 ml/min. CONCLUSION Inappropriate prescribing of renally cleared medications is common among ambulatory older veterans, and only a few medications account for most of these prescribing problems.

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