Abstract
Background
Adverse drug reactions (ADRs) are common in elderly patients. There are various reasons for this, including age- and disease-related alterations in pharmacokinetics and pharmacodynamics as well as the common practice of polypharmacy. The decline in renal function in elderly patients may also predispose them to pharmacological ADRs (type A, augmented). Patients receiving home healthcare may be at even higher risk.
Objectives
To study ADRs as a cause of acute hospital admissions in a defined cohort of elderly patients (aged ≥65 years) registered to receive home healthcare services, with special reference to impaired renal function as a possible risk factor.
Methods
This was a retrospective study of 154 elderly patients aged ≥65 years admitted to the emergency department of a university hospital in Stockholm, Sweden, in October–November 2002. Estimated creatinine clearance (eCLCR) was calculated from the Cockcroft-Gault formula, and estimated glomerular filtration rate (eGFR) by the Modification of Diet in Renal Disease (MDRD) equation. ADRs were defined according to WHO criteria. All medications administered to patients at admission and at discharge were collated. These and other data were collected from computerized hospital records.
Results
ADRs were judged to contribute to or be the primary cause of hospitalization in 22 patients, i.e. 14% of 154 patients registered to receive home healthcare. Eleven of the 22 patients were women. All but one ADR were type A. Excessive doses or drugs unsuitable in renal insufficiency were present in seven patients in the ADR group compared with only four patients in the group without ADRs (p=0.0001). Patients with ADRs did not differ significantly from those without ADRs in relation to age, plasma creatinine, eCLCR, weight or number of drugs prescribed at admission. However, women with ADRs were significantly older than women without ADRs (mean±SD age 88.8±5.7 years vs 82.5±8.0 years, respectively; p=0.014) and had significantly lower mean±SD eCLCR values (25.5±10.8 and 37.1±17.1 mL/min, respectively; p=0.035). Median MDRD eGFR was significantly higher than median eCLCR (59 [range 6–172] mL/min/1.73 m2 vs 38 [range 5–117] mL/min, respectively; p=0.0001).
Conclusions
In elderly patients registered to receive home healthcare, 14% of hospital admissions were primarily caused by ADRs. One-third of these ADRs were related to impaired renal function, generally in very old women. These ADRs may be avoided by close monitoring of renal function and adjustments to pharmacotherapy (drug selection and dose), particularly in very elderly women.
Similar content being viewed by others
References
Muehlberger N, Schneeweiss S, Hasford J. Adverse drug reaction monitoring: cost and benefit considerations. Part I: frequency of adverse drug reactions causing hospital admissions. Pharmacoepidemiol Drug Saf 1997; 6Suppl. 3: S71–7
Lazarou J, Pomeranz BH, Corey PN. Incidence of adverse drug reactions in hospitalized patients: a meta-analysis of prospective studies. JAMA 1998; 279(15): 1200–5
Bergman U, Wiholm BE. Drug-related problems causing admission to a medical clinic. Eur J Clin Pharmacol 1981; 20(3): 193–200
von Euler M, Eliasson E, Öhlén G, et al. Adverse drug reactions causing hospitalization can be monitored from computerized medical records and thereby indicate the quality of drug utilization. Pharmacoepidemiol Drug Saf 2006; 15(3): 179–84
Mjörndal T, Boman MD, Hägg S, et al. Adverse drug reactions as a cause for admissions to a department of internal medicine. Pharmacoepidemiol Drug Saf 2002; 11(1): 65–72
Sarlöv C, Andersén-Karlsson E, von Bahr C. Adverse effects of drugs in patients with heart disease lead to hospital care [in Swedish]. Läkartidningen 2001; 98(47): 5349–53
Pirmohamed M, James S, Meakin S, et al. Adverse drug reactions as cause of admission to hospital: prospective analysis of 18 820 patients. BMJ 2004; 329(7456): 15–9
Leach S, Roy SS. Adverse drug reactions: an investigation on an acute geriatric ward. Age Ageing 1986; 15(4): 241–6
Lindley CM, Tully MP, Paramsothy V, et al. Inappropriate medication is a major cause of adverse drug reactions in elderly patients. Age Ageing 1992; 21(4): 294–300
Routledge PA, O’Mahony MS, Woodhouse KW. Adverse drug reactions in elderly patients. Br J Clin Pharmacol 2004; 57(2): 121–6
Gray SL, Mahoney JE, Blough DK. Adverse drug events in elderly patients receiving home health services following hospital discharge. Ann Pharmacother 1999; 33(11): 1147–53
Hemmelgarn BR, Zhang J, Manns BJ, et al. Progression of kidney dysfunction in the community-dwelling elderly. Kidney Int 2006; 69(12): 2155–61
Edwards IR, Aronson JK. Adverse drug reactions: definitions, diagnosis, and management. Lancet 2000; 356(9237): 1255–9
World Health Organization. Requirements for adverse reaction reporting. Geneva: World Health Organization, 1975
Janusinfo [online]. Available from URL: http://www.janusinfo.se/sfinx/interactions/index_menus.jsp [Accessed 2003 Sep 31]
Cockcroft DW, Gault MH. Prediction of creatinine clearance from serum creatinine. Nephron 1976; 16(1): 31–41
Levey AS, Coresh J, Greene T, et al. Expressing the Modification of Diet in Renal Disease study equation for estimating glomerular filtration rate with standardized serum creatinine values. Clin Chem 2007; 53(4): 766–72
World Health Organization Collaborating Center for Drug Statistics Methodology. ATC index with DDDs. Oslo: WHO, 2005 [online]. Available from URL: http://www.whocc.no/atcddd [Accessed 2009 Jun 18]
Mühlberg W, Platt D. Age-dependent changes of the kidneys: pharmacological implications. Gerontology 1999; 45(5): 243–53
NKF KDOQI guidelines. KDOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Part 4: definition and classification of stages of chronic kidney disease. New York: National Kidney Foundation, Inc., 2002 [online]. Available from URL: http://www.kidney.org/professionals/KDOQI/guidelines_ckd/p4_class_g1.htm [Accessed 2009 Jun 30]
Wiffen P, Gill M, Edwards J. Adverse drug reactions in hospital patients: a systematic review of the prospective and retrospective studies. Bandolier Extra, 2002 Jun [online]. Available from URL: http://www.jr2.ox.ac.uk/bandolier/extra.html [Accessed 2008 Dec 18]
Nisbet JC, Sturtevant JM, Prins JB. Metformin and serious adverse effects. Med J Aust 2004 Jan 19; 180(2): 53–4
Corsonello A, Pedone C, Corica F, et al. Concealed renal insufficiency and adverse drug reactions in elderly hospitalized patients. Arch Intern Med 2005; 165(7): 790–5
Blix HS, Viktil KK, Moger TA, et al. Use of renal risk drugs in hospitalized patients with impaired renal function: an underestimated problem? Nephrol Dial Transplant 2006; 21(11): 3164–71
Granerus G, Aurell M. Reference values for 51Cr-EDTA clearance as a measure of glomerular filtration rate. Scand J Clin Lab Invest 1981; 41(6): 611–6
Rigalleau V, Lasseur C, Perlemoine C, et al. Cockcroft-Gault formula is biased by body weight in diabetic patients with renal impairment. Metabolism 2006; 55(1): 108–12
Spruill WJ, Wade WE, Cobb HH. Comparison of estimated glomerular filtration rate with estimated creatinine clearance in the dosing of drugs requiring adjustments in elderly patients with declining renal function. Am J Geriatr Pharmacother 2008; 6(3): 153–60
Wettermark B, Hammar N, Fored C, et al. The new Swedish Prescribed Drug Register: opportunities for pharmacoepidemiological research and experience from the first six months. Pharmacoepidemiol Drug Saf 2007; 16(7): 726–35
Odar-Cederlöf I, Oskarsson P, Öhlén G, et al. Adverse drug effect as cause of hospital admission: common drugs are the major part according to the cross-sectional study [in Swedish]. Läkartidningen 2008; 105(12–13): 890–3
Statistics Sweden. Senior citizens. In: Statistics Sweden. Demographic reports: the future population of Sweden 2006–2050. Örebro: Statistics Sweden, Forecasting Institute, 2008: 31
Acknowledgements
This study was supported by the Stockholm County Council (ALF 20060747, FOU project no. 560747) and by grants from the Karolinska Institutet. We are grateful to Lars Axelsson for assistance with data from the Huddinge municipality and Dr Bo Herrlin at the Karolinska University Hospital, Huddinge while the study was being conducted. The authors have no conflicts of interest that are directly relevant to the content of this study.
Author information
Authors and Affiliations
Corresponding author
Additional information
An erratum to this article is available at http://dx.doi.org/10.1007/s40266-013-0135-3.
Rights and permissions
About this article
Cite this article
Helldén, A., Bergman, U., von Euler, M. et al. Adverse Drug Reactions and Impaired Renal Function in Elderly Patients Admitted to the Emergency Department. Drugs Aging 26, 595–606 (2009). https://doi.org/10.2165/11315790-000000000-00000
Published:
Issue Date:
DOI: https://doi.org/10.2165/11315790-000000000-00000