Impact of renal aging on drug therapy

Musso, Carlos G.; Scibona, Paula; Bellizzi, Vincenzo; Núñez, Juan F. Macías

doi:10.1080/00325481.2015.1063957

Cited by 16 publications

(5 citation statements)

References 52 publications

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“…WHO suggested that more than 46% of people aged 60+ years having disabilities [26]. Old people were more likely to use health services because they have more health problems and suffer many side effects of treatment [27]. As a result, aging increases the rate of health services use is high that is consistent with findings of previous studies [28,29].…”

Section: Discussionsupporting

confidence: 85%

Health service use and associated factors among old Khmer people: a cross-sectional survey in Tri Ton District, An Giang Province

Neang¹,

Van²,

Gia³

2022

MedPharmRes

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Background: The health status of ethnic minorities of all ages lags far behind that of the general population, particularly in the old. The old minor ethnic population is more likely to have chronic diseases but less likely to access health services. This study assesses the rate of health services use and associated factors in the old Khmer population. Method: A cross-sectional study was conducted on 400 Khmer people aged 60+ year-old from March to May 2020. Eligible participants were randomly recruited from households of five clusters out of nine communes of Tri Ton District, An Giang province, Vietnam. A structured questionnaire was designed to collect data on socio-demography, health status, health service use and accessibility to health services and quality of life. Quality of life was measured using EQ-5D-5L. All eligible participants were face-to-face interviewed by a bilingual researcher. Result: The rate of health services use was 63.3%. The EQ-5D-5L utility index mean score was 0.46 (SD=0.28) and EQ-VAS mean score was 49.01 (SD=16.19). The odds of using health services were higher in those reported to have problems in mobility (OR=2.56, 95%CI 1.43-4.61, p<0.01), self-care (OR=2.05, 95%CI 1.30-3.24, p<0.01), activity (OR=2.35, 95%CI 1.44-3.82, p<0.01), pain/discomfort (OR=2.63, 95%CI 1.22-5.67, p=0.01), and anxiety/depression (OR=2.07, 95%CI 1.00-4.29, p=0.05) in univariate but not in multivariable analysis. The multivariable logistic regression showed that the odds of using health services were lower in those who were currently working (aOR=0.48, 95%CI 0.30-0.79, p<0.01), accessible to health information (aOR=0.47, 95%CI 0.27-0.80, p<0.01), but higher in those using health insurance (aOR=5.09, 95%CI 3.19-8.14, p<0.01), and in health facilities used Khmer language (aOR=2.04, 95%CI 1.15-3.62, p=0.01). Conclusion: This study suggested that Khmer people should be involved in all stages of planning and implementing health programs and services for Khmer communities to improve the accessibility and health equity.

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Section: Discussionsupporting

confidence: 85%

Health service use and associated factors among old Khmer people: a cross-sectional survey in Tri Ton District, An Giang Province

Neang¹,

Van²,

Gia³

2022

MedPharmRes

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“…This decrease in GFR can be explained by an increase in urea excretion and a reduction in creatinine production in older adults. The renal plasma flow is reduced by 50%, and the kidney's ability to increase baseline GFR by at least 20% (the renal reserve) also decreases significantly with ageing [13].…”

Section: Age-related Changes In Pharmacokineticsmentioning

confidence: 99%

“…Sodium reabsorption is reduced in the older adults, and drugs that promote the excretion of salt and water, such as thiazides and loop diuretics, can induce hyponatraemia, hypovolaemia and renal failure. Also, renal excretion of potassium is significantly reduced with ageing, so drugs such as angiotensin-converting-enzyme inhibitor (ACEI), angiotensin II receptor blockers (ARBs), aliskiren, digoxin, potassium-sparing agents, beta-blockers and nonsteroidal anti-inflammatory drugs (NSAIDs) can induce hyperkalaemia [13].…”

Section: Age-related Changes In Pharmacokineticsmentioning

confidence: 99%

Elderly and Polypharmacy: Physiological and Cognitive Changes

Rodrigues¹,

Herdeiro²,

Figueiras³

et al. 2021

Frailty in the Elderly - Understanding and Managing Complexity

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Population ageing is one of the most significant social transformations of the twenty-first century. The increase in average life expectancy was a successful challenge achieved in the modern world. However, nowadays a new challenge arises for all society: achieving a better quality of life for increasing people’s life. The comorbidities associated with ageing make elderly prone to polypharmacy. On the other hand, physiological and cognitive changes interfere with drugs’ pharmacodynamics and pharmacokinetics contributing to drug-related problems which have been reported to account for a large percentage of emergency treatment and hospitalizations of older people, increasing the costs with health in the most aged regions. In order to reduce the use of potentially inappropriate medicines in this population, strategies and tools have been developed in recent years to assess the appropriateness medication use in the elderly.

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“…79 The impact of age-related changes in renal physiology such as low blood flow, GFR reduction, reduced tubular secretion, and tubular frailty on drug therapy has been reviewed recently. 80 Elderly patients (age 65 years and older) use up to 30% of all commonly prescribed medication, and they experience more adverse effects than the general population. Is it due to kidney accumulation of drugs, reduced renal function, and disproportionate DDIs or just polypharmacy?…”

Section: Sensitive Populationsmentioning

confidence: 99%

Renal Transporter‐Mediated Drug‐Drug Interactions: Are They Clinically Relevant?

Lepist

Ray

2016

The Journal of Clinical Pharma

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The kidney, through the distinct processes of passive glomerular filtration and active tubular secretion, plays an important role in the elimination of numerous endobiotics (eg, hormones, metabolites), toxins, nutrients, and drugs. Renal transport pathways mediating active tubular secretion and reabsorption in the proximal tubule are complex, involving apical and basolateral transporters acting in concert. Detailed studies of the molecular mechanisms of net active tubular secretion have established the involvement of multiple transporters with overlapping substrate specificity mediating competing secretion and reabsorption pathways. Although drug interactions arising from inhibition of renal transporters are rare relative to other mechanisms, they can involve commonly administered drugs (eg, cimetidine, metformin), may be underappreciated due to muted effects on plasma pharmacokinetics relative to tissue levels, can affect narrow-therapeutic-index medications (eg, antiarrhythmic, oncology medications), and may disproportionately affect sensitive populations where polypharmacy is common (eg, the elderly, diabetics). In particular, there is the potential for larger-magnitude interactions in subjects with reduced glomerular filtration rates due to the increased relative contribution of tubular secretion. The assessment of additional endpoints in drug-drug interaction studies including pharmacodynamics, positron emission tomography imaging, and metabolomics promises to expand our understanding of the clinical relevance of renal drug interactions.

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Impact of renal aging on drug therapy

Cited by 16 publications

References 52 publications

Health service use and associated factors among old Khmer people: a cross-sectional survey in Tri Ton District, An Giang Province

Health service use and associated factors among old Khmer people: a cross-sectional survey in Tri Ton District, An Giang Province

Elderly and Polypharmacy: Physiological and Cognitive Changes

Renal Transporter‐Mediated Drug‐Drug Interactions: Are They Clinically Relevant?

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