Document Detail

Potentially inappropriate prescribing of primarily renally cleared medications for older veterans affairs nursing home patients.
MedLine Citation:
PMID:  21450179     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Inappropriate prescribing of primarily renally cleared medications in older patients with kidney disease can lead to adverse outcomes.
OBJECTIVES: To estimate the prevalence of potentially inappropriate prescribing of 21 primarily renally cleared medications based on 2 separate estimates of renal function and to identify factors associated with this form of suboptimal prescribing in older VA nursing home (NH) patients.
DESIGN: Longitudinal study
PARTICIPANTS: Participants were 1304 patients, aged 65 years or older, admitted between January 1, 2004, and June 30, 2005, for 90 days or more to 1 of 133 VA NHs.
MAIN MEASURES: Potentially inappropriate prescribing of primarily renally cleared medications determined by estimating creatinine clearance using the Cockcroft Gault (CG) and Modification of Diet in Renal Disease (MDRD) equations and applying explicit guidelines for contraindicated medications and dosing.
KEY RESULTS: The median estimated creatinine clearance via CG was 67 mL/min, whereas it was 80 mL/min/1.73m(2) with the MDRD. Overall, 11.89% patients via CG and only 5.98% via MDRD had evidence of potentially inappropriate prescribing of at least 1 renally cleared medication. The most commonly involved medications were ranitidine, glyburide, gabapentin, and nitrofurantoin. Factors associated with potentially inappropriate prescribing as per the CG were age older than 85 (adjusted odds ratio [AOR] 4.24, 95% confidence interval [CI] 2.42-7.43), obesity (AOR 0.26, 95% CI 0.14-0.50) and having multiple comorbidities (AOR 1.09 for each unit increase in the Charlson comorbidity index, 95% CI 1.01-1.19).
CONCLUSIONS: Potentially inappropriate prescribing of renally cleared medications is common in older VA NH patients. Intervention studies to improve the prescribing of primarily renally cleared medications in nursing homes are needed.
Joseph T Hanlon; Xiaoqiang Wang; Steven M Handler; Steven Weisbord; Mary Jo Pugh; Todd Semla; Roslyn A Stone; Sherrie L Aspinall
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, U.S. Gov't, Non-P.H.S.; Research Support, U.S. Gov't, P.H.S.     Date:  2010-10-02
Journal Detail:
Title:  Journal of the American Medical Directors Association     Volume:  12     ISSN:  1538-9375     ISO Abbreviation:  J Am Med Dir Assoc     Publication Date:  2011 Jun 
Date Detail:
Created Date:  2011-05-25     Completed Date:  2011-09-30     Revised Date:  2014-09-22    
Medline Journal Info:
Nlm Unique ID:  100893243     Medline TA:  J Am Med Dir Assoc     Country:  United States    
Other Details:
Languages:  eng     Pagination:  377-83     Citation Subset:  IM    
Copyright Information:
Copyright © 2011 American Medical Directors Association. Published by Elsevier Inc. All rights reserved.
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MeSH Terms
Aged, 80 and over
Inappropriate Prescribing / trends*
Kidney / metabolism*
Kidney Diseases
Kidney Function Tests
Longitudinal Studies
Nursing Homes*
Odds Ratio
United States
United States Department of Veterans Affairs
Grant Support
K07 AG033174/AG/NIA NIH HHS; K07 AG033174-01A1/AG/NIA NIH HHS; K07 AG033174-02/AG/NIA NIH HHS; K07 AG033174-03/AG/NIA NIH HHS; K07AG033174/AG/NIA NIH HHS; K12 RR023267/RR/NCRR NIH HHS; P30 AG024827/AG/NIA NIH HHS; P30AG024827/AG/NIA NIH HHS; R01 AG034056/AG/NIA NIH HHS; R01 AG034056-01/AG/NIA NIH HHS; R01 AG034056-02/AG/NIA NIH HHS; R01 HS017695/HS/AHRQ HHS; R01 NR010135/NR/NINR NIH HHS; R01AG027017/AG/NIA NIH HHS; R01AG034056/AG/NIA NIH HHS; R34 MH082682/MH/NIMH NIH HHS; R56 AG027017/AG/NIA NIH HHS; R56 AG027017-04/AG/NIA NIH HHS; T32 AG021885/AG/NIA NIH HHS
Comment In:
J Am Med Dir Assoc. 2012 Jan;13(1):e5; author reply e6   [PMID:  21763209 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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