Skip to main content
SpringerLink
Log in

Polypharmacy and Renal Failure in Nursing Home Residents: Results of the Inappropriate Medication in Patients with Renal Insufficiency in Nursing Homes (IMREN) Study

  • Short Communication
  • Published:
Drugs & Aging Aims and scope Submit manuscript

Abstract

Background

Polypharmacy has become an emerging public health issue in recent years, since use of multiple medications or polypharmacy is beneficial for many conditions, but may also have negative effects like adverse drug reactions. The risk further increases in patients with chronic renal failure, a comorbidity very frequent in nursing home residents. Since more than 50 % of all drugs were renally excreted, dose adjustments in patients with renal failure are required.

Objective

To assess polypharmacy in German nursing homes, in particular in residents with renal failure.

Methods

Multi-center cross-sectional study in 21 nursing homes in Bremen and Lower Saxony/Germany. Baseline data were analysed using descriptive statistics. Multivariable logistic regression model and 95 % confidence intervals were used to study the association of renal failure and polypharmacy.

Results

Of all 852 residents, the analysis comprised those 685 with at least one serum creatinine value so that the estimated creatinine clearance could be calculated. Of those, 436 (63.6 %) had a severe or moderate renal failure, defined as estimated creatinine clearance <60 mL/min. Polypharmacy (5–9 drugs) was found in 365 (53.3 %) and excessive polypharmacy (≥10 drugs) in 112 (16.4 %) residents. Diuretics and psycholeptics were the most commonly used drug classes. Severe renal failure (estimated creatinine clearance <30 mL/min) was associated with polypharmacy (OR: 2.8, 95 % CI 1.4–5.7).

Conclusion

Both, polypharmacy and renal failure are common in German nursing home residents and an association of both could be found. Further studies are needed to assess the appropriateness of polypharmacy in these patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

References

  1. Chang YP, Huang SK, Tao P, et al. A population-based study on the association between acute renal failure (ARF) and the duration of polypharmacy. BMC Nephrol. 2012;13:96.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Grimmsmann T, Himmel W. Polypharmacy in primary care practices: an analysis using a large health insurance database. Pharmacoepidemiol Drug Saf. 2009;18:1206–13.

    Article  PubMed  Google Scholar 

  3. Reuther S, van Nie N, Meijers J, et al. Malnutrition and dementia in the elderly in German nursing homes: results of a prevalence survey from the years 2008 and 2009 [in German]. Z Gerontol Geriatr. 2013;46:260–7.

    Article  PubMed  CAS  Google Scholar 

  4. Meyer G, Köpke S, Haastert B, et al. Restraint use among nursing home residents: cross-sectional study and prospective cohort study. J Clin Nurs. 2009;18:981–90.

    Article  PubMed  Google Scholar 

  5. Hoffmann F, Kaduszkiewicz H, Glaeske G, et al. Prevalence of dementia in nursing home and community-dwelling older adults in Germany. Aging Clin Exp Res. 2014;26(5):555–9.

    Article  PubMed  Google Scholar 

  6. Gordon AL, Franklin M, Bradshaw L, et al. Health status of UK care home residents: a cohort study. Age Ageing. 2014;43:97–103.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Onder G, Liperoti R, Fialova D, et al. Polypharmacy in nursing home in Europe: results from the SHELTER study. J Gerontol A Biol Sci Med Sci. 2012;67A:698–704.

    Article  Google Scholar 

  8. Junius-Walker U, Theile G, Hummers-Pradier E. Prevalence and predictors of polypharmacy among older primary care patients in Germany. Fam Pract. 2007;24:14–9.

    Article  PubMed  CAS  Google Scholar 

  9. Mckillop G, Joy J. Patients’ experience and perceptions of polypharmacy in chronic kidney disease and its impact on adherent behaviour. J Ren Care. 2013;39:200–7.

    Article  PubMed  Google Scholar 

  10. Fincke BG, Snyder K, Cantillon C, et al. Three complementary definitions of polypharmacy: methods, application and comparison of findings in a large prescription database. Pharmacoepidemiol Drug Saf. 2005;14:121–8.

    Article  PubMed  Google Scholar 

  11. Beloosesky Y, Nenaydenko O, Gross Nevo RF, et al. Rates, variability, and associated factors of polypharmacy in nursing home patients. Clin Interv Aging. 2013;8:1585–90.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Reason B, Terner M, Moses McKeag A, et al. The impact of polypharmacy on the health of Canadian seniors. Fam Pract. 2012;29:427–32.

    Article  PubMed  Google Scholar 

  13. Ahmed B, Nanji K, Mujeeb R, et al. Effects of polypharmacy on adverse drug reactions among geriatric outpatients at a tertiary care hospital in Karachi: a prospective cohort study. PLoS One. 2014;9:e112133.

    Article  PubMed  PubMed Central  Google Scholar 

  14. 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.

    Article  PubMed  Google Scholar 

  15. 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.

    Article  PubMed  Google Scholar 

  16. Martin-Facklam M, Rengelshausen J, Tayrouz Y, et al. Dose individualisation in patients with renal insufficiency: does drug labelling support optimal management? Eur J Clin Pharmacol. 2005;60:807–11.

    Article  PubMed  Google Scholar 

  17. Hartmann B, Czock D, Keller F. Drug therapy in patients with chronic renal failure. Dtsch Arztebl Int. 2010;107:647–55.

    PubMed  PubMed Central  Google Scholar 

  18. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Rahimi AR, Kennedy K, Thomason M, et al. Improper renal dosing in long-term care facilities. South Med J. 2008;101:802–5.

    Article  PubMed  Google Scholar 

  20. 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.

    Article  PubMed  CAS  Google Scholar 

  21. Jokanovic N, Tan EC, Dooley MJ, et al. Prevalence and factors associated with polypharmacy in long-term care facilities: a systematic review. J Am Med Dir Assoc. 2015;16:535.e1–535.e12.

  22. Schaeffner ES, Ebert N, Delanaye P, et al. Two novel equations to estimate kidney function in persons aged 70 years or older. Ann Intern Med. 2012;157:471–81.

    Article  PubMed  Google Scholar 

  23. Adams G, Gulliford MC, Ukoumunne OC, et al. Patterns of intra-cluster correlation from primary care research to inform study design and analysis. J Clin Epidemiol. 2004;57:785–94.

    Article  PubMed  Google Scholar 

  24. Aguilar EA, Ashraf H, Frontini M, et al. An analysis of chronic kidney disease risk factors in a Louisiana nursing home population: a cross-sectional study. J La State Med Soc. 2013;165(260–3):265–7.

    Google Scholar 

  25. Chan TC, Yap DYH, Shea YF, et al. Prevalence and associated comorbidities of moderate to severe chronic renal impairment in Chinese nursing home older adults. J Am Med Dir Assoc. 2012;13:630–3.

    Article  PubMed  Google Scholar 

  26. Schnelle J, Osterweil D, Globe D, et al. Chronic kidney disease, anemia, and the association between chronic kidney disease-related anemia and activities of daily living in older nursing home residents. J Am Med Dir Assoc. 2009;10:120–6.

    Article  PubMed  Google Scholar 

  27. Robinson B, Artz AS, Culleton B, et al. Prevalence of anemia in the nursing home: contribution of chronic kidney disease. J Am Geriatr Soc. 2007;55:1566–70.

    Article  PubMed  Google Scholar 

  28. WHO. Obesity: preventing and managing the global epidemic. World Health Organ Tech Rep Ser. 2000;894:i–xii, 1–253.

  29. DGE Deutsche Gesellschaft für Ernährung. Press information. 2006. Available from: https://www.dge.de/presse/pm/die-deutschen-werden-immer-dicker. Accessed 28 Oct 2015.

  30. Masoodi NA. Polypharmacy: to err is human, to correct divine. Br J Med Pract. 2008;1:6–9.

    Google Scholar 

  31. Franco Palacios CR, Haugen EN, Rasmussen RW, et al. Avoidance of polypharmacy and excessive blood pressure control is associated with improved renal function in older patients. Ren Fail. 2015;12:1–5.

    Google Scholar 

  32. Meulendijk MC, Spruit MR, Drenth-van Maanen AC, et al. Computerized decision support improves medication review effectiveness: an experiment evaluating the STRIP Assistant’s usability. Drugs Aging. 2015;32(6):495–503.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgments

The authors would like to thank Mandy Köhrmann and Katharina Allers for electronic recording of the questionnaires, Birgitt Wiese for biometric support, Daniela Boeschen and Jana Petersen for organizational and scientific support, Christian Scholz for technical support, all of the participating nursing homes, and KfH-Stiftung Präventivmedizin for funding.

Author information

Authors and Affiliations

  1. Department of Health Services Research, Carl von Ossietzky University Oldenburg, Ammerländer Heerstrasse 140, 26111, Oldenburg, Germany

    Michael Dörks & Falk Hoffmann

  2. Department of Medicine, Rotes Kreuz Hospital, Bremen, Germany

    Stefan Herget-Rosenthal

  3. Department of Health Services Research, Institute for Public Health and Nursing Science, University of Bremen, Bremen, Germany

    Guido Schmiemann

Authors
  1. Michael Dörks
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Stefan Herget-Rosenthal
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Guido Schmiemann
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Falk Hoffmann
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Michael Dörks.

Ethics declarations

Funding

This work was supported by KfH-Stiftung Präventivmedizin, a non-profit, charitable foundation. KfH-Stiftung Präventivmedizin was not involved in the scientific analyses and had no influence on the manuscript and the publication process.

Conflict of interest

Michael Dörks, Stefan Herget-Rosenthal, Guido Schmiemann and Falk Hoffmann declare that they have no conflicts of interest relevant to the content of this article.

Ethical Approval

This study was approved by the Ethics Committee of the University of Bremen, Bremen, Germany.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Dörks, M., Herget-Rosenthal, S., Schmiemann, G. et al. Polypharmacy and Renal Failure in Nursing Home Residents: Results of the Inappropriate Medication in Patients with Renal Insufficiency in Nursing Homes (IMREN) Study. Drugs Aging 33, 45–51 (2016). https://doi.org/10.1007/s40266-015-0333-2

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40266-015-0333-2

Keywords

Search

Navigation