Inappropriate prescribing in patients with renal impairment

Abstract

OBJECTIVES: The aim of this study was to assess the prevalence of inappropriate prescribing (IP) in an acute care hospital and to identify medication classes that are inappropriately prescribed. IP occurs in patients with poor renal function in hospital and in outpatient settings. The extent

of IP among patients with impaired renal function varies between countries and medical specialties.

METHODS: The retrospective descriptive study included patients aged 18 years and older who were admitted to hospital for more than 24 h with documented estimated glomerular fltration rate (eGFR) <60 ml/min/1.73 m2 and were receiving at least one systemic medication. Patient data, medications and eGFR results were compiled from the electronic health records. IP was assessed taking into consideration the eGFR, absolute glomerular fltration rate (absGFR) and estimated creatinine clearance (eCrCl).

KEY FINDINGS: The study included 399 patients (63% female; 37% male) with an average age of 79 years (range 42–99). At least one inappropriate prescription was prescribed to 236 (59.1%) patients and 90 patients (38.1%) received ≥3 inappropriately prescribed medications. The prevalence of IP was 32.0% (n = 790), 29.2% (n = 568) and 30.6% (n = 596) when eGFR, absGFR and eCrCl values were used, respectively. Anticoagulants (n = 261, 43.6%) were the most inappropriately prescribed class of medication followed by analgesics (n = 85, 33.9%) and antidiabetic agents (n = 55, 39.6%).

CONCLUSIONS: Results of the study show that dosage adjustment of medication in renal impairment to avoid IP needs to be addressed. Choice of renal function estimate did not significantly affect the overall prevalence of IP among the study population.