European Journal of Clinical Pharmacology

, Volume 75, Issue 11, pp 1503–1511 | Cite as

Effectiveness of using STOPP/START criteria to identify potentially inappropriate medication in people aged ≥ 65 years with chronic kidney disease: a randomized clinical trial

  • Krystina ParkerEmail author
  • Ingrid Bull-Engelstad
  • Jūratė Šaltytė Benth
  • Willy Aasebø
  • Nanna von der Lippe
  • Morten Reier-Nilsen
  • Ingrid Os
  • Knut Stavem
Clinical Trial



Polypharmacy and inappropriate prescribing are common in elderly with chronic kidney disease (CKD). This study identified potentially inappropriate prescriptions (PIPs) and potential prescribing omissions (PPOs) using the Screening Tool of Older Persons’ Prescriptions (STOPP) and the Screening Tool to Alert doctors to the Right Treatment (START) criteria in elderly with advanced CKD and determined the effect of a medication review on medication adherence and health-related quality of life (HRQoL).


The intervention consisted of a medication review using STOPP/START criteria with a recommendation to a nephrologist or similar review without a recommendation. End points were prevalence of PIP and PPO, medication adherence, and HRQoL. Group differences in outcomes were assessed using a generalized linear mixed model. The trial was registered under (ID: NCT02424786).


We randomized 180 patients with advanced CKD (mean age 77 years, 23% female). The prevalence of PIPs and PPOs in the intervention group was 54% and 50%, respectively. The odds of PPOs were lower in the intervention than the control group (OR 0.42, 95% CI 0.19–0.92, p = 0.032), while there was no intergroup difference in the number of PIPs (OR 0.57, CI 0.27–1.20, p = 0.14). There was no difference in changes in medication adherence or HRQoL from baseline to 6 months between the groups.


The intervention with the STOPP/START criteria identified a high prevalence of inappropriate medications in the elderly with advanced CKD and reduced the number of PPOs. However, there was no detectable impact of the intervention on medication adherence or HRQoL.


Polypharmacy Chronic kidney disease Medication adherence Elderly Inappropriate medication 



The use of the Morisky Medication Adherence Scale (© MMAS) is protected by US copyright laws. Permission for use is required. A license agreement is available from Donald E. Morisky at or MMAS Research LLC 14725 NE 20th ST. Bellevue, WA 98007.

Authors’ contributions

K.P. and K.S. designed the study with support from the other authors. K.P., M.R.N., I.B.E., W.A., and N.v.d.L. participated in screening, recruitment, and data collection. K.S., J.Š.B., and K.P. analyzed the data. K.P. drafted the manuscript with support from K.S. All of the authors contributed to data interpretation, critically reviewed the manuscript, and approved its final version.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Supplementary material

228_2019_2727_MOESM1_ESM.docx (15 kb)
ESM 1 (DOCX 15 kb)
228_2019_2727_MOESM2_ESM.docx (14 kb)
ESM 2 (DOCX 14 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Nephrology, Medical DivisionAkershus University HospitalLørenskogNorway
  2. 2.Faculty of Medicine, Institute of Clinical MedicineUniversity of OsloOsloNorway
  3. 3.Department of Nephrology, Medical Division, Vestre Viken HFDrammen HospitalDrammenNorway
  4. 4.Department of Health Services Research UnitAkershus University HospitalLørenskogNorway
  5. 5.Department of Nephrology, Medical DivisionOslo University Hospital UllevålOsloNorway
  6. 6.Department of Pulmonary Medicine, Medical DivisionAkershus University HospitalLørenskogNorway

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