Abstract
Background
Because the elderly are often treated by multiple-drug regimens, their iatrogenic risks are considerably raised. However, despite the serious side-effects that diuretic agents may have in this population, SPCs (summary of product characteristics) do not specify how often serum chemistry should be monitored. This study of long-term diuretic therapy prescription and monitoring in elderly patients was conducted by the Department of Clinical Pharmacology of the Nantes teaching hospital in collaboration with the medical department of the French national health insurance scheme.
Methods
Data were extracted from the French national health insurance database. Patients were 75 years old or more and had been receiving a diuretic agent for 1 year or longer. The patients were classified into two groups: one group included those patients whose serum chemistry had been monitored at least once (electrolyte levels and/or urea and creatinine blood levels); the other group included the non-monitored patients.
Results
Mean patient age was 80 ± 4.6 (SD) years. The non-monitored patients represented 22.8% of the cohort. The at-risk patients were mainly women suffering from no severe disease, treated by a single practitioner (often a general practitioner) and/or always receiving the same type of diuretic agent.
Conclusion
Many elderly patients receiving diuretic agents do not benefit from regular serum chemistry monitoring. The prescription of serum chemistry assays is correlated to the presence of various patient-related risk factors. Recommendations should be made to help practitioners to ensure a minimal serum chemistry monitoring in all elderly patients receiving diuretics.
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Abbreviations
- AFSSAPS:
-
Agence Française de Sécurité Sanitaire des Produits de Santé (French agency for the safety of healthcare products)
- CNAM:
-
Caisse Nationale d’Assurance Maladie (France’s mandatory national health insurance fund)
- SIAM:
-
Système d’Information de l’Assurance Maladie (French electronic health insurance data transfer system)
- SPC:
-
Summary of product characteristics
References
Agence Française de Sécurité Sanitaire des Produits de Santé (2005) Mise au point: Prévenir la iatrogénie médicamenteuse chez le sujet âgé. http://afssaps.sante.fr/htm/10/iatro/iatro.pdf. Accessed 10 Nov 2007
Vogel T, Kaltenbach G, Dick M, Martin-Hunyadi C, Heitz D, Kiesmann M, Berthel M, Kuntzmann F (2002) L’iatrogénie chez la personne âgée. Concours Med 124(3):178–184
Aresu PJ, Othoniel J, Marti Y, Callis A, Piperno M (2001) Acute hypernatremic dehydratation in elderly. Concours Med 123(17):1166–1171
Fradet G, Legac X, Charlois T, Ponge T, Cottin S (1996) Iatrogenic pathology in elderly, inducing hospitalisation. A one year retrospective study in an internal medicine department. Rev Med Interne 17(6):456–460
Gonthier R, Cathebras P (1999) Multiple diseases in the elderly: therapeutic management and avoidable pitfalls: Drugs and the elderly. Presse Med 28(32):1780–1788
Victorri-Vigneau C, Basset G, Jolliet P (2006) How a novel programme for increasing awareness of health professionals resulted in a 14% decrease in patients using excessive doses of psychotropic drugs in western France. Eur J Clin Pharmacol 62(4):311–316
Doucet J, Capet C, Jégo A, Trivalle C, Noël D, Chassagne P, Bercoff E (1999) Undesirable drug effects in the elderly: epidemiology and prevention. Presse Med 28(32):1789–1793
Adrogué HJ (2005) Consequences of inadequate management of hyponatremia. Am J Nephrol 25(3):240–249
Palmer BF, Gates JR, Lader M (2003) Causes and management of hyponatremia. Ann Pharmacother 37(11):1694–1702
Schwab M, Roder F, Morike K, Thon KP, Klotz U (1999) Drug-induced hyponatraemia in elderly patients. Br J Clin Pharmacol 48(1):105–106
Baglin A, Boulard JC, Hanslik T, Prinseau J (1995) Metabolic adverse reactions to diuretics. Clinical relevance to elderly patients. Drug Saf 12(3):161–167
Agence Française de Sécurité Sanitaire des Produits de Santé (2003) Références Médicales Opposables. Diagnostic et traitement de l’hypertension artérielle essentielle de l’adulte en dehors de la grossesse. http://agmed.sante.gouv.fr/htm/5/5210c.htm#hypert. Accessed 10 Nov 2007
Presne C, Monge M, Mansour J, Oprisiu R Choukroun G, Achard JM, Fournier A (2007) Diuretic-based therapy. Nephrol Ther 3(6):392–426
http://www.theriaque.org/InfoMedicaments/home.cfm. Accessed 10 Nov 2007
Rutten FH, Grobbee DE, Hoes AW (2003) Differences between general practitioners and cardiologists in diagnosis and management of heart failure: a survey in every-day practice. Eur J Heart Fail 5(3):337–344
Fantino B, Voirin N, Laforest L, Fantino F, Chretin S, Van Ganse E (2006) Primary care physicians’ behaviors towards risk of iatrogenesis in elderly patients. Eur J Clin Pharmacol 62(7):563–570
Gurwitz JH, Avorn J (1991) The ambiguous relation between aging and adverse drug reactions. Ann Intern Med 114(11):956–966
Julien J (1998) Diuretics: principles and rules of use. Rev Prat 48(8):913–918
Bönte M, Von Dem Knesebeck O, Siegrist J, Marceau L, Link C, McKinlay J (2007) Influence of patient’s age and gender on doctors’ decision making about coronary heart disease. Dtsch Med Wochenschr 132(43):2251–2255
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Gérardin-Marais, M., Victorri-Vigneau, C., Allain-Veyrac, G. et al. Diuretic drug therapy monitoring in the elderly: a cohort study. Eur J Clin Pharmacol 64, 433–437 (2008). https://doi.org/10.1007/s00228-007-0431-0
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DOI: https://doi.org/10.1007/s00228-007-0431-0