John Libbey Eurotext

Néphrologie & Thérapeutique

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Médicaments potentiellement inappropriés et charge anticholinergique et sédative chez les patients âgés ambulatoires atteints de maladie rénale chronique avancée Article à paraître

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Auteurs
1 Charpennes Hospital, Pharmaceutical Unit, University Hospital of Lyon, 69100 Villeurbanne, France
2 Day-care unit, Charpennes Hospital, University Hospital of Lyon, 69100 Villeurbanne, France
3 University Lyon 1, 69008 Lyon, France
4 INSERM U1028; CNRS UMR5292; Lyon Neuroscience Research Center, Brain Dynamics and Cognition Team, 69675 Bron, France
5 University Lyon 1, Research on Healthcare Performance (RESHAPE), INSERM U1290, 69008 Lyon, France
Correspondance : T. Novais

Objective

Regarding older patients, multiple chronic conditions lead to the intake of multiple medications, involving a higher risk of adverse drug events. In older patients with advanced chronic kidney disease, the medication exposure was poorly explored. The aim of this study was to describe the use of potentially inappropriate medications and medications with anticholinergic and sedative properties in older community-dwelling patients with advanced chronic kidney disease.

Methods

An observational study was conducted in a geriatric day-care unit. All patients aged over 65 years with advanced chronic kidney disease, defined by estimated glomerular filtration rate < 20 mL/min/1.73 m2 or estimated glomerular filtration rate > 20 mL/min/1.73 m2 with rapid progression, and referred by nephrologist for pretransplant comprehensive geriatric assessment, were included in the study. Potentially inappropriate medications were identified using the EU(7)-PIM list, and he anticholinergic and sedative drug exposure was measured using the Drug Burden Index.

Results

Overall, 139 patients were included in the study (mean age 74.4 ± 3.3 years, 32.4% females, 61.9% on dialysis). Potentially inappropriate medications were used by 74.1% (103/139) of patients and were mainly represented by proton pump inhibitors, alpha-1-blockers and central antihypertensive drugs. Regarding anticholinergic and / or sedative medications, 79.9% (111/139) of older patients were exposed.

Conclusion

In older community-dwelling patients with advanced chronic kidney disease, the prevalence of potentially inappropriate medication exposure and anticholinergic and sedative exposure was high. Interventions focusing on deprescription of these inappropriate medications should be conducted in this specific population.