Potentially inappropriate medications prescribing to elderly patients with advanced chronic kidney by using 2019 American Geriatrics Society Beers Criteria

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Abstract

Background and aims

A potentially inappropriate medication (PIM) is defined as a drug‐carrying risks outweighing the expected clinical benefits. Elderly patients with chronic kidney disease (CKD) are particularly at higher risk of drug‐related toxicities. In Lebanon, no studies have been conducted regarding the prescribing of PIMs in hospitalized CKD patients. This study aimed to check the prevalence of PIMs using the American Geriatrics Society (AGS) Beers criteria in elderly patients with advanced CKD stages including dialysis and to identify possible risk factors that may be associated with prescribing PIMs in this population.

Methods

A retrospective cross‐sectional study was conducted on patients with advanced CKD above the age of 65 years and admitted between January 2019 and June 2019 to two University Hospitals in Beirut, Lebanon. We used multiple logistic regression analysis to determine which factors were associated with prescription of PIMs according to AGS Beers criteria‐2019.

Results

The study sample included 199 patients with renal dysfunction, 75.9% were aged 70 years or more, 53.8% were females, and 61.8% were prescribed five drugs or more. Eighty‐two patients were receiving hemodialysis (41.2%). PIMs prevalence was 34.1% (68/199 patients) according to Beers criteria in elderly patients with advanced CKD stages.

The most frequently prescribed PIMs were ranitidine (39.1%), enoxaparin (25%), tramadol (9.8%), and ciprofloxacin (5.4%). Polypharmacy (OR 2.1, CI 95% 1.58‐2.79), a higher number of comorbidities (OR 3.01, CI 95% 1.43‐6.30), and coronary artery diseases (OR 3.14 CI 95% 1.44‐6.85) were the factors associated with an increased risk of at least one PIM prescription.

Conclusion

Our study found that one out of three patients with advanced CKD had at least one PIM according to the latest Beers criteria. A large proportion of inappropriate prescribing is preventable by increasing awareness of prescribing physicians to the explicit lists of PIMs.

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Most cited references 34

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Global, regional, and national burden of chronic kidney disease, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017

Boris Bikbov, Caroline A. Purcell, Andrew Levey … (2021)

Summary Background Health system planning requires careful assessment of chronic kidney disease (CKD) epidemiology, but data for morbidity and mortality of this disease are scarce or non-existent in many countries. We estimated the global, regional, and national burden of CKD, as well as the burden of cardiovascular disease and gout attributable to impaired kidney function, for the Global Burden of Diseases, Injuries, and Risk Factors Study 2017. We use the term CKD to refer to the morbidity and mortality that can be directly attributed to all stages of CKD, and we use the term impaired kidney function to refer to the additional risk of CKD from cardiovascular disease and gout. Methods The main data sources we used were published literature, vital registration systems, end-stage kidney disease registries, and household surveys. Estimates of CKD burden were produced using a Cause of Death Ensemble model and a Bayesian meta-regression analytical tool, and included incidence, prevalence, years lived with disability, mortality, years of life lost, and disability-adjusted life-years (DALYs). A comparative risk assessment approach was used to estimate the proportion of cardiovascular diseases and gout burden attributable to impaired kidney function. Findings Globally, in 2017, 1·2 million (95% uncertainty interval [UI] 1·2 to 1·3) people died from CKD. The global all-age mortality rate from CKD increased 41·5% (95% UI 35·2 to 46·5) between 1990 and 2017, although there was no significant change in the age-standardised mortality rate (2·8%, −1·5 to 6·3). In 2017, 697·5 million (95% UI 649·2 to 752·0) cases of all-stage CKD were recorded, for a global prevalence of 9·1% (8·5 to 9·8). The global all-age prevalence of CKD increased 29·3% (95% UI 26·4 to 32·6) since 1990, whereas the age-standardised prevalence remained stable (1·2%, −1·1 to 3·5). CKD resulted in 35·8 million (95% UI 33·7 to 38·0) DALYs in 2017, with diabetic nephropathy accounting for almost a third of DALYs. Most of the burden of CKD was concentrated in the three lowest quintiles of Socio-demographic Index (SDI). In several regions, particularly Oceania, sub-Saharan Africa, and Latin America, the burden of CKD was much higher than expected for the level of development, whereas the disease burden in western, eastern, and central sub-Saharan Africa, east Asia, south Asia, central and eastern Europe, Australasia, and western Europe was lower than expected. 1·4 million (95% UI 1·2 to 1·6) cardiovascular disease-related deaths and 25·3 million (22·2 to 28·9) cardiovascular disease DALYs were attributable to impaired kidney function. Interpretation Kidney disease has a major effect on global health, both as a direct cause of global morbidity and mortality and as an important risk factor for cardiovascular disease. CKD is largely preventable and treatable and deserves greater attention in global health policy decision making, particularly in locations with low and middle SDI. Funding Bill & Melinda Gates Foundation.

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American Geriatrics Society 2019 Updated AGS Beers Criteria® for Potentially Inappropriate Medication Use in Older Adults

(2019)

The American Geriatrics Society (AGS) Beers Criteria® (AGS Beers Criteria®) for Potentially Inappropriate Medication (PIM) Use in Older Adults are widely used by clinicians, educators, researchers, healthcare administrators, and regulators. Since 2011, the AGS has been the steward of the criteria and has produced updates on a 3-year cycle. The AGS Beers Criteria® is an explicit list of PIMs that are typically best avoided by older adults in most circumstances or under specific situations, such as in certain diseases or conditions. For the 2019 update, an interdisciplinary expert panel reviewed the evidence published since the last update (2015) to determine if new criteria should be added or if existing criteria should be removed or undergo changes to their recommendation, rationale, level of evidence, or strength of recommendation. J Am Geriatr Soc 67:674-694, 2019.

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American Geriatrics Society 2015 Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults.

(2015)

The 2015 American Geriatrics Society (AGS) Beers Criteria are presented. Like the 2012 AGS Beers Criteria, they include lists of potentially inappropriate medications to be avoided in older adults. New to the criteria are lists of select drugs that should be avoided or have their dose adjusted based on the individual's kidney function and select drug-drug interactions documented to be associated with harms in older adults. The specific aim was to have a 13-member interdisciplinary panel of experts in geriatric care and pharmacotherapy update the 2012 AGS Beers Criteria using a modified Delphi method to systematically review and grade the evidence and reach a consensus on each existing and new criterion. The process followed an evidence-based approach using Institute of Medicine standards. The 2015 AGS Beers Criteria are applicable to all older adults with the exclusion of those in palliative and hospice care. Careful application of the criteria by health professionals, consumers, payors, and health systems should lead to closer monitoring of drug use in older adults.

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Author and article information

Contributors

Bahia Chahine:

ORCID: https://orcid.org/0000-0002-4204-359X

bahia.chahine@liu.edu.lb

Journal

Journal ID (nlm-ta): Health Sci Rep

Journal ID (iso-abbrev): Health Sci Rep

Journal ID (doi): 10.1002/(ISSN)2398-8835

Journal ID (publisher-id): HSR2

Title: Health Science Reports

Publisher: John Wiley and Sons Inc. (Hoboken )

ISSN (Electronic): 2398-8835

Publication date (Electronic): 07 December 2020

Publication date Collection: December 2020

Volume: 3

Issue: 4 ( doiID: 10.1002/hsr2.v3.4 )

Electronic Location Identifier: e214

Affiliations

[ ¹ ] School of Pharmacy Lebanese International University Beirut Lebanon

Author notes

[*] [* ] Correspondence

Bahia Chahine, School of Pharmacy, Lebanese International University, Beirut, Lebanon.

Email: bahia.chahine@ 123456liu.edu.lb

Author information

Bahia Chahine https://orcid.org/0000-0002-4204-359X

Article

Publisher ID: HSR2214

DOI: 10.1002/hsr2.214

PMC ID: 7720279

PubMed ID: 33313424

SO-VID: 197b25b7-7cee-4ddc-a820-5a342d46db16

License:

This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

History

Date received : 14 May 2020

Date revision received : 13 October 2020

Date accepted : 12 November 2020

Page count

Figures: 1, Tables: 3, Pages: 7, Words: 4719

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source-schema-version-number 2.0

cover-date December 2020

details-of-publishers-convertor Converter:WILEY_ML3GV2_TO_JATSPMC version:5.9.5 mode:remove_FC converted:07.12.2020

Keywords: beers criteria,chronic kidney disease,hemodialysis,potentially inappropriate medication

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Keywords: beers criteria, chronic kidney disease, hemodialysis, potentially inappropriate medication

Potentially inappropriate medications prescribing to elderly patients with advanced chronic kidney by using 2019 American Geriatrics Society Beers Criteria

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Most cited references 34

Global, regional, and national burden of chronic kidney disease, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017

American Geriatrics Society 2019 Updated AGS Beers Criteria® for Potentially Inappropriate Medication Use in Older Adults

American Geriatrics Society 2015 Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults.

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