The effect of hospitalization on potentially inappropriate medication use in older adults with chronic kidney disease

Wubshet H. Tesfaye, Barbara C. Wimmer, Gregory M. Peterson, Ronald L. Castelino, Matthew D. Jose, Charlotte McKercher, Syed Tabish R. Zaidi

Research output: Contribution to journalArticle

Abstract

Objectives: Potentially inappropriate medication (PIM) use is associated with increased morbidity and mortality in chronic kidney disease (CKD). However, there is a paucity of data on how hospitalization affects PIM use in older adults with CKD. Therefore, we aimed to measure the impact of hospitalization on PIM use in older CKD patients, and identify factors predicting PIM use. Methods: A retrospective cohort study was conducted in older adults (≥65 years) with CKD admitted to an Australian tertiary care hospital over a 6 month period. PIM use was measured, upon admission and at discharge, using the Medication Appropriateness Index (MAI) and Beers criteria (2015 version) for medications recommended to be avoided in older adults and under certain conditions. Results: The median age of the 204 patients was 83 years (interquartile range (IQR): 76–87 years) and most were men (61%). Overall, the level of PIM use (MAI) decreased from admission to discharge (median [IQR]: 6 [3–12] to 5 [2–9]; p <.01]). More than half of the participants (55%) had at least one PIM per Beers criterion on admission, which was reduced by discharge (48%; p <.01). People admitted with a higher number of medications (β 0.72, 95% CI 0.56–0.88) and lower eGFR values (β − 0.11, 95% CI −0.18 to −0.04) had higher MAI scores after adjusting for age, sex and Charlson’s comorbidity index. Conclusions: PIMs were commonly used in older CKD patients. Hospitalization was associated with a reduction in PIM use, but there was considerable scope for improvement in these susceptible individuals.

Original languageEnglish
Pages (from-to)1119-1126
Number of pages8
JournalCurrent Medical Research and Opinion
Volume35
Issue number6
DOIs
Publication statusPublished - 3 Jun 2019
Externally publishedYes

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Chronic Renal Insufficiency
Hospitalization
Potentially Inappropriate Medication List
Tertiary Healthcare
Tertiary Care Centers
Comorbidity
Cohort Studies
Retrospective Studies
Morbidity

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Tesfaye, Wubshet H. ; Wimmer, Barbara C. ; Peterson, Gregory M. ; Castelino, Ronald L. ; Jose, Matthew D. ; McKercher, Charlotte ; Zaidi, Syed Tabish R. / The effect of hospitalization on potentially inappropriate medication use in older adults with chronic kidney disease. In: Current Medical Research and Opinion. 2019 ; Vol. 35, No. 6. pp. 1119-1126.
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abstract = "Objectives: Potentially inappropriate medication (PIM) use is associated with increased morbidity and mortality in chronic kidney disease (CKD). However, there is a paucity of data on how hospitalization affects PIM use in older adults with CKD. Therefore, we aimed to measure the impact of hospitalization on PIM use in older CKD patients, and identify factors predicting PIM use. Methods: A retrospective cohort study was conducted in older adults (≥65 years) with CKD admitted to an Australian tertiary care hospital over a 6 month period. PIM use was measured, upon admission and at discharge, using the Medication Appropriateness Index (MAI) and Beers criteria (2015 version) for medications recommended to be avoided in older adults and under certain conditions. Results: The median age of the 204 patients was 83 years (interquartile range (IQR): 76–87 years) and most were men (61{\%}). Overall, the level of PIM use (MAI) decreased from admission to discharge (median [IQR]: 6 [3–12] to 5 [2–9]; p <.01]). More than half of the participants (55{\%}) had at least one PIM per Beers criterion on admission, which was reduced by discharge (48{\%}; p <.01). People admitted with a higher number of medications (β 0.72, 95{\%} CI 0.56–0.88) and lower eGFR values (β − 0.11, 95{\%} CI −0.18 to −0.04) had higher MAI scores after adjusting for age, sex and Charlson’s comorbidity index. Conclusions: PIMs were commonly used in older CKD patients. Hospitalization was associated with a reduction in PIM use, but there was considerable scope for improvement in these susceptible individuals.",
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The effect of hospitalization on potentially inappropriate medication use in older adults with chronic kidney disease. / Tesfaye, Wubshet H.; Wimmer, Barbara C.; Peterson, Gregory M.; Castelino, Ronald L.; Jose, Matthew D.; McKercher, Charlotte; Zaidi, Syed Tabish R.

In: Current Medical Research and Opinion, Vol. 35, No. 6, 03.06.2019, p. 1119-1126.

Research output: Contribution to journalArticle

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T1 - The effect of hospitalization on potentially inappropriate medication use in older adults with chronic kidney disease

AU - Tesfaye, Wubshet H.

AU - Wimmer, Barbara C.

AU - Peterson, Gregory M.

AU - Castelino, Ronald L.

AU - Jose, Matthew D.

AU - McKercher, Charlotte

AU - Zaidi, Syed Tabish R.

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N2 - Objectives: Potentially inappropriate medication (PIM) use is associated with increased morbidity and mortality in chronic kidney disease (CKD). However, there is a paucity of data on how hospitalization affects PIM use in older adults with CKD. Therefore, we aimed to measure the impact of hospitalization on PIM use in older CKD patients, and identify factors predicting PIM use. Methods: A retrospective cohort study was conducted in older adults (≥65 years) with CKD admitted to an Australian tertiary care hospital over a 6 month period. PIM use was measured, upon admission and at discharge, using the Medication Appropriateness Index (MAI) and Beers criteria (2015 version) for medications recommended to be avoided in older adults and under certain conditions. Results: The median age of the 204 patients was 83 years (interquartile range (IQR): 76–87 years) and most were men (61%). Overall, the level of PIM use (MAI) decreased from admission to discharge (median [IQR]: 6 [3–12] to 5 [2–9]; p <.01]). More than half of the participants (55%) had at least one PIM per Beers criterion on admission, which was reduced by discharge (48%; p <.01). People admitted with a higher number of medications (β 0.72, 95% CI 0.56–0.88) and lower eGFR values (β − 0.11, 95% CI −0.18 to −0.04) had higher MAI scores after adjusting for age, sex and Charlson’s comorbidity index. Conclusions: PIMs were commonly used in older CKD patients. Hospitalization was associated with a reduction in PIM use, but there was considerable scope for improvement in these susceptible individuals.

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KW - chronic kidney disease

KW - elderly

KW - Medication Appropriateness Index

KW - potentially inappropriate medications

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