The Role of Deprescribing in Older Adults with Chronic Kidney Disease

Triantafylidis, Laura K.; Hawley, Chelsea E.; Perry, Linda L.; Paik, Julie M.

doi:10.1007/s40266-018-0593-8

Cited by 47 publications

(38 citation statements)

References 85 publications

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“…At the end of this medication review, physicians should limit the number of medications as far as possible, but the development of an algorithm ensuring that the highest priority drugs are prescribed in this population is essential. Limiting the number of medications should also improve patient adherence but deprescribing is a real challenge [49,50]. After this showing of the exposure of elderly people with advanced CKD to both RIM and PIM, further studies must examine the impact of deprescription of these targeted medications.…”

Section: Discussionmentioning

confidence: 99%

Medication burden and inappropriate prescription risk among elderly with advanced chronic kidney disease

et al. 2020

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Background: Elderly patients with chronic kidney disease (CKD) frequently present comorbidities that put them at risk of polypharmacy and medication-related problems. This study aims to describe the overall medication profile of patients aged ≥75 years with advanced CKD from a multicenter French study and specifically the renally (RIMs) and potentially inappropriate-for-the-elderly medications (PIMs) that they take.Methods: This is a cross-sectional analysis of medication profiles of individuals aged ≥75 years with eGFR < 20 ml/min/1.73 m2 followed by a nephrologist, who collected their active prescriptions at the study inclusion visit. Medication profiles were first analyzed according to route of administration, therapeutic classification. Second, patients were classified according to their risk of potential medication-related problems, based on whether the prescription was a RIM or a PIM. RIMs and PIMs have been defined according to renal appropriateness guidelines and to Beer's criteria in the elderly. RIMs were subclassified by 4 types of category: (a) contraindication; (b) dose modification is recommended based on creatinine clearance (CrCl); (c) dose modification based on CrCl is not recommended but a maximum daily dose is mentioned, (d) no specific recommendations based on CrCl: "use with caution", "avoid in severe impairment", "careful monitoring of dose is required" "reduce the dose". Results:We collected 5196 individual medication prescriptions for 556 patients, for a median of 9 daily medications [7][8][9][10][11]. Antihypertensive agents, antithrombotics, and antianemics were the classes most frequently prescribed. Moreover, 77.0% of patients had at least 1 medication classified as a RIM. They accounted 31.3% of the drugs prescribed and 9.25% was contraindicated drugs. At least 1 PIM was taken by 57.6 and 45.5% of patients had at least one medication classified as RIM and PIM. The prescriptions most frequently requiring reassessment due to potential adverse effects were for proton pump inhibitors and allopurinol. The PIMs for which deprescription is especially important in this population are rilmenidine, long-term benzodiazepines, and anticholinergic drugs such as hydroxyzine.(Continued on next page) Conclusion: We showed potential drug-related problems in elderly patients with advanced CKD. Healthcare providers must reassess each medication prescribed for this population, particularly the specific medications identified here.Trial registration: NCT02910908.

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Section: Discussionmentioning

confidence: 99%

Medication burden and inappropriate prescription risk among elderly with advanced chronic kidney disease

et al. 2020

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“…At the end of this medication review, physicians should limit the number of medications as far as possible, but the development of an algorithm ensuring that the highest priority drugs are prescribed in this population is essential. Limiting the number of medications should also improve patient adherence but deprescribing is a real challenge (41,42). After this showing of the exposure of elderly people with advanced CKD to both RIM and PIM, further studies must examine the impact of deprescription of these targeted medications.…”

Section: Discussionmentioning

confidence: 99%

Medication Burden and Inappropriate Prescription Risk Among Elderly With Advanced Chronic Kidney Disease

Roux-Marson

Baranski

Fafin

et al. 2019

Preprint

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Background Elderly patients with chronic kidney disease (CKD) frequently present comorbidities that put them at risk of polypharmacy and medication-related problems. This study aims to describe the overall medication profile of patients aged ≥ 75 years with advanced CKD from a multicenter French study and specifically the renally (RIMs) and potentially inappropriate-for-the-elderly medications (PIMs) that they take. Methods This is a cross-sectional analysis of medication profiles of individuals aged ≥ 75 years with eGFR < 20 ml/min/1.73m2 followed by a nephrologist, who collected their active prescriptions at the study inclusion visit. Medication profiles were analyzed according to route of administration, therapeutic classification, and their potential inappropriateness for these patients, according to Beers' criteria. Results We collected 5196 individual medication prescriptions for 556 patients, for a median of 9 daily medications [7-11]. Antihypertensive agents, antithrombotics, and antianemics were the classes most frequently prescribed. Moreover, 88% of patients had at least 1 medication classified as a RIM, and 21% of those were contraindicated drugs. At least 1 PIM was taken by 68.9%. The prescriptions most frequently requiring reassessment due to potential adverse effects were for proton pump inhibitors and allopurinol. The PIMs for which deprescription is especially important in this population are rilmenidine, long-term benzodiazepines, and anticholinergic drugs such as hydroxyzine. Conclusion We showed potential drug-related problems in elderly patients with advanced CKD. Healthcare providers must reassess each medication prescribed for this population, particularly the specific medications identified here.

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“…Withdrawing inappropriate antihypertensive agents was also associated with fewer cardiovascular events and deaths over a 5-year follow-up period (86). Deprescribing drugs has also been shown to be effective in older patients with chronic kidney disease who have a very high pill burden (87). However, it is not always easy to select hypertensive patients in whom a drug withdrawal or a drug reduction could be beneficial without increasing the risk of a cardiovascular event.…”

Section: Deprescription and Discontinuation Of Drug Therapymentioning

confidence: 99%