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

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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.

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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.

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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
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  2. Stefan Herget-Rosenthal
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  3. Guido Schmiemann
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  4. Falk Hoffmann
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Corresponding author

Correspondence to Michael Dörks.

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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.

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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

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

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