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Komplikationen durch Diuretikatherapie bei geriatrischen Patienten

Diuretics-related complications in elderly patients

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Summary

Diuretics are well studied and evaluated for their beneficial use in geriatric patients. However those drugs are often used without taking care of subjects condition or functional impairment. Known side effects of those substances may be increased by combinations of multiple drugs. Polypharmacy is a strong risk factor for the incidence of adverse drug reactions (ADR). ADRs are frequently found in combination with the use of diuretics. The remodelling of human body in aging process and uncontrolled therapeutic strategies seem to be causal for that finding. This article tries to work out the potential risk of the usage of those drugs in geriatric patients and its clinical relevance by using literature published in PubMed.

Zusammenfassung

Diuretika sind für die Anwendung bei geriatrischen Patienten in Hinblick auf ihre Wirksamkeit evaluiert. Die Wirkstoffe dieser Gruppen werden jedoch oft ohne Rücksichtnahme auf den Zustand und funktionelle Einschränkungen des Patienten verordnet. In vielen Fällen verstärken sich bekannte unerwünschte Nebenwirkungen durch Zusammenwirken mehrerer Wirkstoffe. Polypragmasie ist ein bedeutender Risikofaktor für Adverse-drug-reactions (ADR). Diese ADRs treten bei alten Patienten besonders häufig im Zusammenhang mit dem Einsatz von Diuretika auf. Ursächlich scheint neben dem Umbau des Körpers im Alter auch eine unkontrollierte Therapieführung zu sein. Die vorliegende Arbeit versucht unter Verwendung von Literatur aus PubMed die potentielle Gefahr einer Therapie mit diuretischen Wirkstoffen bei geriatrischen Patienten und die daraus resultierende klinische Relevanz darzustellen.

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Literatur

  • Pitt B, Zannad F, Remme WJ, Cody R, Castaigne A, Perez A, Palensky J, Wittes J. The effect of spironolactone on morbidity and mortality in patients with severe heart failure – Randomized Aldactone Evaluation Study Investigators. N Engl J Med, 341: 709–717, 1999

    Article  CAS  PubMed  Google Scholar 

  • Juurlink DN, Mamdani MM, Lee DS, et al. Rates of hyperkalemia after publication of the randomized aldactone evaluation study. N Engl J Med, 351: 543–551, 2004

    Article  CAS  PubMed  Google Scholar 

  • Nigel S. Treatment of hypertension in patients 80 years of age or older. NEJM, 358: 1887–1898, 2008

    Article  Google Scholar 

  • Dahlöf B, Lindholm LH, Hansson L, et al. Morbidity and mortality in the Swedish Trial in Old Patients with Hypertension – (STOP-Hypertension). Lancet, 338: 1281–1285, 1991

    Article  PubMed  Google Scholar 

  • Schoeller DA. Changes in total body water with age. Am J Clin Nutr, 50: 1176–1181, 1989

    CAS  PubMed  Google Scholar 

  • Chumlea WC, Guo SS, Zeller CM, Reo NV, Siervogel RM. Total body water data for white adults 18 to 64 years of age: the Fels Longitudinal Study. Kidney Int, 56: 244–252, 1999

    Article  CAS  PubMed  Google Scholar 

  • Silva FG. The aging kidney: a review. Part 1. Int Urol Nephrol, 37: 185–205, 2005

    Article  PubMed  Google Scholar 

  • Molaschi M, Ponzetto M, Massaia M, et al. Hypernatremic dehydration in the elderly on admission to hospital. J Nutr Health Aging, 1: 156–160, 1997

    CAS  PubMed  Google Scholar 

  • Lavizzo-Mourey R, Johnson J, Stolley P. Risk factors for dehydration among elderly nursing home residents. J Am Geriatr Soc, 36: 213–218, 1988

    Article  CAS  PubMed  Google Scholar 

  • Macías-Núñez JF, López-Novoa JM, Martínez-Maldonado M. Acute renal failure in the aged. Semin Nephrol, 16: 330–338, 1996

    PubMed  Google Scholar 

  • Lameire N, Hoste E, Van Loo A, Dhondt A, Bernaert P, Vanholder R. Pathophysiology, causes and prognosis of acute renal failure in the elderly. Ren Fail, 18: 333–346, 1996

    Article  CAS  PubMed  Google Scholar 

  • Weinberg AD, Pals JK, Levesque PG, Beal LF, Cunningham TJ, Minaker KL. Dehydration and death during febrile episodes in the nursing home. J Am Geriatr Soc, 42: 968–971, 1994

    Article  CAS  PubMed  Google Scholar 

  • Mann SJ. The silent epidemic of thiazide-induced hyponatremia. J Clin Hypertens, 10: 477–484, 2008

    Article  CAS  Google Scholar 

  • Rosner MH. Severe hyponatremia associated with the combined use of thiazide diuretics and selective serotonin reuptake inhibitors. Am J Med Sci, 327: 109–111, 2004

    Article  PubMed  Google Scholar 

  • Ashouri OS. Severe diuretic-induced hyponatremia in the elderly. A series of eight patients. Arch Intern Med, 146: 1355–1357, 1986

    Article  CAS  PubMed  Google Scholar 

  • Flamenbaum W. Diuretic use in the elderly: potential for diuretic-induced hypokalemia. Am J Cardiol, 57: 38A–43A, 1986

    Article  CAS  PubMed  Google Scholar 

  • Passare G, Viitanen M, Törring O, Winblad B, Fastbom J. Sodium and potassium disturbances in the elderly: prevalence and association with drug use. Clin Drug Investig, 24: 535–544, 2004

    Article  CAS  PubMed  Google Scholar 

  • Katerinis I, Fumeaux Z. Hypokalemia: diagnosis and treatment. Rev Med Suisse, 3: 579–582, 2007

    CAS  PubMed  Google Scholar 

  • Kokot F, Hyla-Klekot L. Drug-induced abnormalities of potassium metabolism. Pol Arch Med Wew, 118: 431–433, 2008

    CAS  Google Scholar 

  • Wozakowska-Kaplon B, Janowska-Molenda I. Iatrogenic hyperkalemia as a serious problem in therapy of cardiovascular diseases in elderly patients. Pol Arch Med Wewn, 119: 141–147, 2009

    PubMed  Google Scholar 

  • Jennings M, Shortland JR, Maddocks JL. Interstitial nephritis associated with frusemide. J R Soc Med, 79: 239–240, 1986

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Magil AB, Ballon HS, Cameron EC, Rae A. Acute interstitial nephritis associated with thiazide diuretics. Clinical and pathologic observations in three cases. Am J Med, 69: 939–943, 1980

    Article  CAS  PubMed  Google Scholar 

  • Newstead CG, Moore RH, Barnes AJ. Interstitial nephritis associated with indapamide. BMJ, 300(6735): 1344, 1990

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Cuculi F, Suter A, Erne P. Spironolactone-induced gynecomastia. CMAJ, 176: 620, 2007

    Article  PubMed  PubMed Central  Google Scholar 

  • Pirmohamed M, James S, Meakin S, Green C, Scott AK, Walley TJ, Farrar K, Park BK, Breckenridge AM. Adverse drug reactions as cause of admission to hospital: prospective analysis of 18 820 patients. BMJ, 329(7456): 15–19, 2004

    Article  PubMed  PubMed Central  Google Scholar 

  • Davies EC, Green CF, Taylor S, Williamson PR, Mottram DR, Pirmohamed M. Adverse drug reactions in hospital in-patients: a prospective analysis of 3695 patient-episodes. PLoS One, 4: e4439, 2009 [Epub 2009 Feb 11]

    Article  PubMed  PubMed Central  Google Scholar 

  • Michenot F, Sommet A, Bagheri H, Lapeyre-Mestre M, Montastruc JL. Adverse drug reactions in patients older than 70 years during the heat wave occurred in France in summer 2003: A study from the French PharmacoVigilance Database. Pharmacoepidemiol Drug Saf, 15: 735–740, 2006

    Article  CAS  PubMed  Google Scholar 

  • Passarelli MC, Jacob-Filho W, Figueras A. Adverse drug reactions in an elderly hospitalised population: inappropriate prescription is a leading cause. Drugs Aging, 22: 767–777, 2005

    Article  PubMed  Google Scholar 

  • Beltrami GC, Menegolli GP, Corrà L, Weber U, Longobardi A, Albiero A, Conati GF, Grezzana M, Vecchiato D, Fusi F, Grezzana LG. Drug adverse effects in the elderly hospitalized with acute pathologies. Clin Ter, 151: 19–23, 2000

    CAS  PubMed  Google Scholar 

  • Onder G, Pedone C, Landi F, Cesari M, Della Vedova C, Bernabei R, Gambassi G. Adverse drug reactions as cause of hospital admissions: results from the Italian Group of Pharmacoepidemiology in the Elderly (GIFA). J Am Geriatr Soc, 50: 1962–1968, 2002

    Article  PubMed  Google Scholar 

  • Borchelt M. Potential side-effects and interactions in multiple medication in elderly patients: methodology and results of the Berlin Study of Aging. Z Gerontol Geriatr, 28: 420–428, 1995

    CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Universitätsklinik für Innere Medizin, Medizinische Universität Graz, Graz, Austria

    Ronald Otto & Regina E. Roller

  2. Universitätsklinik für Geriatrie, Paracelsus Medizinische Privatuniversität, Salzburg, Austria

    Bernhard Iglseder

  3. Abteilung für Akutgeriatrie/Remobilisation, Landeskrankenhaus Gmunden, Gmunden, Austria

    Peter Dovjak

  4. Abteilung für Innere Medizin und Akutgeriatrie, Landeskrankenhaus Hochzirl, Zirl, Austria

    Monika Lechleitner, Ursula Benvenuti-Falger & Markus Gosch

  5. Abteilung für Akutgeriatrie, Krankenhaus Hietzing mit Neurologischem Zentrum Rosenhügel, Wien, Austria

    Ulrike Sommeregger

  6. Anstaltsapotheke, Krankenhaus Hietzing mit Neurologischem Zentrum Rosenhügel, Wien, Austria

    Birgit Böhmdorfer

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  1. Ronald Otto
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  2. Regina E. Roller
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  4. Peter Dovjak
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  7. Ursula Benvenuti-Falger
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  8. Birgit Böhmdorfer
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  9. Markus Gosch
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Correspondence to Markus Gosch.

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Otto, R., Roller, R., Iglseder, B. et al. Komplikationen durch Diuretikatherapie bei geriatrischen Patienten. Wien Med Wochenschr 160, 276–280 (2010). https://doi.org/10.1007/s10354-010-0786-1

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  • DOI: https://doi.org/10.1007/s10354-010-0786-1

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