Elderly patients with chronic kidney disease (CKD) frequently present comorbidities that put them at risk of polypharmacy and medication-related problems. This study aims to describe the overall medication profile of patients aged ≥75 years with advanced CKD from a multicenter French study and specifically the renally (RIMs) and potentially inappropriate-for-the-elderly medications (PIMs) that they take. This is a cross-sectional analysis of medication profiles of individuals aged ≥75 years with eGFR < 20 ml/min/1.73 m2 followed by a nephrologist, who collected their active prescriptions at the study inclusion visit. Medication profiles were first analyzed according to route of administration, therapeutic classification. Second, patients were classified according to their risk of potential medication-related problems, based on whether the prescription was a RIM or a PIM. RIMs and PIMs have been defined according to renal appropriateness guidelines and to Beer’s criteria in the elderly. RIMs were subclassified by 4 types of category: (a) contraindication; (b) dose modification is recommended based on creatinine clearance (CrCl); (c) dose modification based on CrCl is not recommended but a maximum daily dose is mentioned, (d) no specific recommendations based on CrCl: “use with caution”, “avoid in severe impairment”, “careful monitoring of dose is required” “reduce the dose”. We collected 5196 individual medication prescriptions for 556 patients, for a median of 9 daily medications [7–11]. Antihypertensive agents, antithrombotics, and antianemics were the classes most frequently prescribed. Moreover, 77.0% of patients had at least 1 medication classified as a RIM. They accounted 31.3% of the drugs prescribed and 9.25% was contraindicated drugs. At least 1 PIM was taken by 57.6 and 45.5% of patients had at least one medication classified as RIM and PIM. The prescriptions most frequently requiring reassessment due to potential adverse effects were for proton pump inhibitors and allopurinol. The PIMs for which deprescription is especially important in this population are rilmenidine, long-term benzodiazepines, and anticholinergic drugs such as hydroxyzine. We showed potential drug-related problems in elderly patients with advanced CKD. Healthcare providers must reassess each medication prescribed for this population, particularly the specific medications identified here. NCT02910908.

中文翻译：

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晚期慢性肾脏病老年人的药物负担和不适当的处方风险

患有慢性肾脏疾病（CKD）的老年患者经常出现合并症，使他们处于多药房和药物相关问题的风险中。这项研究旨在描述一项来自多中心法国研究的≥CKD≥75岁的患者的总体用药概况，尤其是肾病（RIMs）和所服用的潜在不适合老年人的药物（PIMs）。这是对eGFR <20 ml / min / 1.73 m2的≥75岁个体的药物分布的横断面分析，随后是肾脏科医生，他们在研究纳入研究时收集了他们的有效处方。首先根据给药途径，治疗分类分析药物概况。其次，根据潜在的药物相关问题的风险对患者进行分类，基于处方是RIM还是PIM。RIM和PIM已根据肾脏适应性指南和老年人的Beer标准进行了定义。RIM分为4类：（a）禁忌症；（b）建议根据肌酐清除率（CrCl）调整剂量；（c）不推荐基于CrCl的剂量修改，但提到最大每日剂量；（d）没有基于CrCl的具体建议：“谨慎使用”，“避免严重损害”，“需要仔细监测剂量” “减少剂量”。我们为556名患者收集了5196份个人用药处方，中位数为9种每日用药[7-11]。降压药，抗血栓药和抗贫血药是最常开的处方。此外，77。0％的患者至少有1种归类为RIM的药物。他们占处方药的31.3％，而禁忌药占9.25％。57.6的患者服用了至少1种PIM，45.5％的患者至少有一种药物被归类为RIM和PIM。由于潜在的不良反应，最经常需要重新评估的处方是质子泵抑制剂和别嘌呤醇。在此人群中，处方尤为重要的PIM是来美尼定，长期苯二氮卓类药物和抗胆碱能药物（例如羟嗪）。我们显示了晚期CKD老年患者潜在的药物相关问题。医疗保健提供者必须重新评估为此人群开出的每种药物，尤其是此处确定的特定药物。NCT02910908。25％是禁忌药。57.6的患者服用了至少1种PIM，45.5％的患者至少有一种药物被归类为RIM和PIM。由于潜在的不良反应，最经常需要重新评估的处方是质子泵抑制剂和别嘌呤醇。在此人群中，处方尤为重要的PIM是来美尼定，长期苯二氮卓类药物和抗胆碱能药物（例如羟嗪）。我们显示了晚期CKD老年患者潜在的药物相关问题。医疗保健提供者必须重新评估针对该人群的每种处方药，尤其是此处确定的特定药物。NCT02910908。25％是禁忌药。57.6的患者服用了至少1种PIM，45.5％的患者至少有一种药物被归类为RIM和PIM。由于潜在的不良反应，最经常需要重新评估的处方是质子泵抑制剂和别嘌呤醇。在此人群中，处方尤为重要的PIM是来美尼定，长期苯二氮卓类药物和抗胆碱能药物（例如羟嗪）。我们显示了晚期CKD老年患者潜在的药物相关问题。医疗保健提供者必须重新评估为此人群开出的每种药物，尤其是此处确定的特定药物。NCT02910908。由于潜在的不良反应，最经常需要重新评估的处方是质子泵抑制剂和别嘌呤醇。在此人群中，处方尤为重要的PIM是来美尼定，长期苯二氮卓类药物和抗胆碱能药物（例如羟嗪）。我们显示了晚期CKD老年患者潜在的药物相关问题。医疗保健提供者必须重新评估为此人群开出的每种药物，尤其是此处确定的特定药物。NCT02910908。由于潜在的不良反应，最经常需要重新评估的处方是质子泵抑制剂和别嘌呤醇。在此人群中，处方尤为重要的PIM是来美尼定，长期苯二氮卓类药物和抗胆碱能药物（例如羟嗪）。我们显示了晚期CKD老年患者潜在的药物相关问题。医疗保健提供者必须重新评估为此人群开出的每种药物，尤其是此处确定的特定药物。NCT02910908。我们显示了晚期CKD老年患者潜在的药物相关问题。医疗保健提供者必须重新评估为此人群开出的每种药物，尤其是此处确定的特定药物。NCT02910908。我们显示了晚期CKD老年患者潜在的药物相关问题。医疗保健提供者必须重新评估为此人群开出的每种药物，尤其是此处确定的特定药物。NCT02910908。