The effect of hospitalization on potentially inappropriate medication use in older adults with chronic kidney disease

Abstract

Objectives: Potentially inappropriate medication (PIM) use is associated with increased morbidity and mortality in chronic kidney disease (CKD). However, there is a paucity of data on how hospitalization affects PIM use in older adults with CKD. Therefore, we aimed to measure the impact of hospitalization on PIM use in older CKD patients, and identify factors predicting PIM use.

Methods: A retrospective cohort study was conducted in older adults (≥65 years) with CKD admitted to an Australian tertiary care hospital over a 6 month period. PIM use was measured, upon admission and at discharge, using the Medication Appropriateness Index (MAI) and Beers criteria (2015 version) for medications recommended to be avoided in older adults and under certain conditions.

Results: The median age of the 204 patients was 83 years (interquartile range (IQR): 76–87 years) and most were men (61%). Overall, the level of PIM use (MAI) decreased from admission to discharge (median [IQR]: 6 [3–12] to 5 [2–9]; p < .01]). More than half of the participants (55%) had at least one PIM per Beers criterion on admission, which was reduced by discharge (48%; p < .01). People admitted with a higher number of medications (β 0.72, 95% CI 0.56–0.88) and lower eGFR values (β − 0.11, 95% CI −0.18 to −0.04) had higher MAI scores after adjusting for age, sex and Charlson’s comorbidity index.

Conclusions: PIMs were commonly used in older CKD patients. Hospitalization was associated with a reduction in PIM use, but there was considerable scope for improvement in these susceptible individuals.

Keywords:

• Beers criteria
• chronic kidney disease
• Medication Appropriateness Index
• elderly
• potentially inappropriate medications

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Declaration of funding

This study was not funded. Author contributions: W.H.T., S.T.R.Z., R.L.C. and B.C.W. have contributed to the conception, design, analyses and manuscript preparation. G.M.P., M.D.J. and C.M. have contributed in the analyses, reviewing intellectual content and manuscript preparation.

Declaration of financial/other relationships

W.H.T., S.T.R.Z., R.L.C., B.C.W., G.M.P. and C.M. have no relevant financial interests or other relationships to declare. M.D.J. has disclosed that he is a consultant nephrologist at the renal unit of the Royal Hobart Hospital. CMRO peer reviewers on this manuscript have no relevant financial or other relationships to disclose.