Polypharmacy associated with renal impairment in elderly people attending primary health care centers

Abstract

Purpose: This study aimed to estimate the prevalence of renal impairment among primary health care (PHC) elderly, its association with polypharmacy, and the most frequent potentially inappropriate prescription (PIP) in renal impairment patients. Methods: A cross-sectional study was conducted among PHC clinic attendees aged 65 and older. We used medical records and an interviewer-administered questionnaire for data collection. Participants with eGFR less than 60mls/min/1.73m2 were categorized as renal impaired; we then calculated the prevalence of renal impairment and used multivariable analysis to identify its predictors. Beer's criteria and literature reviews were used to evaluate renal impairment patients' medication and to determine the frequency of PIPs. Results: The study included 421 participants (224 female, 197 male), and 66.3% were between the ages of 65 and 75. The prevalence of renal impairment was 30.2% (95%CI: 25.8-34.6%). Polypharmacy [aOR= 5.9, 95%CI: 2.4-14.6], stroke [aOR= 2.5, 95%CI: 1.2-5.4], Females [aOR= 2.6, 95%CI: 1.5-4.7], and elderly over the age of 80 [aOR= 4.4, 95%CI: 2.2-8.8] were the main predictors of renal impairment. RAAS (54.3%), metformin (39.3%) and sulfonylurea (20.4%) were the most frequent reported PIP in renal impairment patients. Conclusion: Renal impairment affects nearly one-third of elderly Palestinians who attend PHC clinics and has been strongly linked to polypharmacy in this population. Stroke, age, and gender are other identified risk factors in our study. It is recommended to raise healthcare providers' awareness to control elderly patients’ chronic conditions by cautiously prescribing only necessary medication, choosing non-nephrotoxic alternatives, and monitoring their renal function frequently.