Potentially inappropriate medication in patients with chronic kidney disease and elderly patients

Background: Most patients with chronic kidney disease (CKD) are old, co morbid, and subjected to polypharmacy. This study describes prevalence and predictors of potentially inappropriate medication (PIM) in CKD patients. Materials and methods: Medication plans of CKD patients of the "Greifswald Approach to Individualized Medicine" cross-sectional study (GANI_MED) were checked for PIM based on kidney function (PIM-K) and PIM for elderly patients (PIM-E). PIM-K were defined by prescription instructions of product labeling. PIM-E were defined by BEERS, PRISCUS, and FORTA criteria. Predictors for PIM were identified through multiple stepwise regression. Results: 375 patients were included (age: 67.9 +/- 13.5 years; estimated glomerular filtration rate (eGFR): 23.3 +/- 18.6 mL/min/1.73m(2); prescriptions: 11.1 +/- 4.7). 44.5% of all CKD patients had PIM-K, and 43.2 to 79.0% of all elderly patients had PIM-E. Polypharmacy and reduced eGFR were predictors for PIM. The risk for PIM-K was increased by 3.8 (95% confidence interval (CI): 1.5 - 9.6) with 10 or more prescriptions and by 8.7 (95% CI: 1.3 - 58.5) with an eGFR below 30 mL/ min/1.73m(2). On average, elderly patients with 10 or more prescriptions had 3.0 +/- 1.7 PIM-E. Conclusion: Polypharmacy, PIM-K,and PIM-E affect many CKD patients and can lead to adverse events. Deprescribing and targeted prescribing may improve the outcome of CKD patients and elderly patients.