Summary
Background
Use of potentially inappropriate medications may result in increased morbidity, mortality and resource utilisation. Due to polypharmacy and age-related decline in renal function the elderly population is at particular risk. Therefore, the Beers Criteria include use of nonsteroidal anti-inflammatory drugs in chronic renal failure stage 4 and 5 as these drugs may worsen renal function. According to the summary of product characteristics, the nonsteroidal anti-inflammatory drugs ibuprofen and diclofenac are contraindicated in these patients.
Objective was to assess the extent of nonsteroidal anti-inflammatory drug use in nursing homes with a focus on residents with severe renal failure.
Methods
Multi-centre cross-sectional study in 21 German nursing homes. The study population comprised residents for whom at least one serum creatinine value and information about sex were available, so that creatinine clearance rate could be estimated.
Results
In all, 685 of 852 residents were included as they fulfilled the abovementioned criteria. Renal failure was severe (estimated creatinine clearance rate < 30 ml/min) in 106 residents (15.5 %). Approximately one-fifth was treated with at least one nonsteroidal anti-inflammatory drug in both the total study population (20.3 %) and that with severe renal failure (20.8 %). With one exception, all residents prescribed nonsteroidal anti-inflammatory drugs with severe renal failure were treated with at least one nonsteroidal anti-inflammatory drug that was contraindicated due to the underlying renal function.
Conclusions
Notwithstanding their classification as potentially inappropriate medications and underlying contraindications, use of nonsteroidal anti-inflammatory drugs is common among nursing home residents with severe renal failure.
This is a preview of subscription content, log in via an institution to check access.
References
Colloca G, Tosato M, Vetrano DL, et al. Inappropriate drugs in elderly patients with severe cognitive impairment: results from the shelter study. PLoS One. 2012;7: e46669.
Mann E, Haastert B, Böhmdorfer B, et al. Prevalence and associations of potentially inappropriate prescriptions in Austrian nursing home residents: secondary analysis of a cross-sectional study. Wien Klin Wochenschr. 2013;125:180–8.
Stafford AC, Alswayan MS, Tenni PC. Inappropriate prescribing in older residents of Australian care homes. J Clin Pharm Ther. 2011;36:33–44.
Hefner G, Stieffenhofer V, Gabriel S, et al. Side effects related to potentially inappropriate medications in elderly psychiatric patients under everyday pharmacotherapy. Eur J Clin Pharmacol. 2015;71:165–72.
Jones SA, Bhandari S. The prevalence of potentially inappropriate medication prescribing in elderly patients with chronic kidney disease. Postgrad Med J. 2013;89:247–50.
Campanelli CM; The American Geriatrics Society 2012 Beers Criteria Update Expert Panel. Updated Beers Criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2012;60:616–31.
Modig S, Lannering C, Ostgren CJ, et al. The assessment of renal function in relation to the use of drugs in elderly in nursing homes; a cohort study. BMC Geriatr. 2011;11:1.
Joseph J, Koka M, Aronow WS. Prevalence of moderate and severe renal insufficiency in older persons with hypertension, diabetes mellitus, coronary artery disease, peripheral arterial disease, ischemic stroke, or congestive heart failure in an academic nursing home. J Am Med Dir Assoc. 2008;9:257–9.
Garg AX, Papaioannou A, Ferko N, et al. Estimating the prevalence of renal insufficiency in seniors requiring long-term care. Kidney Int. 2004;65:649–53.
Ingrasciotta Y, Sultana J, Giorgianni F, et al. The burden of nephrotoxic drug prescriptions in patients with chronic kidney disease: a retrospective population-based study in Southern Italy. PLoS One 2014;9:e89072.
Ingrasciotta Y, Sultana J, Giorgianni F, et al. Association of individual non-steroidal anti-inflammatory drugs and chronic kidney disease: a population-based case control study. PLoS One. 2015;10:e0122899.
Hanlon JT, Wang X, Handler SM, et al. Potentially inappropriate prescribing of primarily renally cleared medications for older veterans affairs nursing home patients. J Am Med Dir Assoc. 2011;12:377–83.
Papaioannou A, Clarke JA, Campbell G, et al. Assessment of adherence to renal dosing guidelines in long-term care facilities. J Am Geriatr Soc. 2000;48:1470–3.
Rahimi AR, Kennedy K, Thomason M, et al. Improper renal dosing in long-term care facilities. South Med J. 2008;101:802–5.
Schneider V, Lévesque LE, Zhang B, et al. Association of selective and conventional nonsteroidal antiinflammatory drugs with acute renal failure: a population-based, nested case-control analysis. Am J Epidemiol. 2006;164:881–9.
Schubert I, Küpper-Nybelen J, Ihle P, et al. Prescribing potentially inappropriate medication (PIM) in Germany’s elderly as indicated by the PRISCUS list. An analysis based on regional claims data. Pharmacoepidemiol Drug Saf. 2013;22:719–27.
Barnett K, McCowan C, Evans JMM, et al. Prevalence and outcomes of use of potentially inappropriate medicines in older people: cohort study stratified by residence in nursing home or in the community. BMJ Qual Saf. 2011;20:275–81.
Acknowledgments
The study was financially supported by the “KfH-Stiftung Präventivmedizin”. The “KfH-Stiftung Präventivmedizin” was not involved in the scientific analyses and had no influence on the manuscript and the publication process.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
The study was approved by the Ethics Committee of the University Bremen.
Conflict of interest
Michael Dörks, Stefan Herget-Rosenthal, Guido Schmiemann, and Falk Hoffmann declare that there are no actual or potential conflicts of interest in relation to this article.
Rights and permissions
About this article
Cite this article
Dörks, M., Herget-Rosenthal, S., Schmiemann, G. et al. Use of nonsteroidal anti-inflammatory drugs and renal failure in nursing home residents—results of the study “Inappropriate Medication in Patients with Renal Insufficiency in Nursing Homes”. Wien Klin Wochenschr 128, 287–290 (2016). https://doi.org/10.1007/s00508-015-0919-z
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00508-015-0919-z