Influence of polypharmacy and use of inappropriate medication for the elderly on the glomerular filtration rate
Keywords:Glomerular filtration rate; Polypharmacy; Potentially inappropriate medication; Aged.
Objective: To investigate the association between the change in the estimated Glomerular Filtration Rate in elderly people with the use of Potentially Inappropriate Medicines for the elderly and polypharmacy. Methodology: Cross-sectional and analytical study based on data from 1216 elderly users of the Public Health System who had estimated Glomerular Filtration Rate exams, the same being considered altered when <60mL / min / 1.73m2. Descriptive analyzes, univariate analysis “chi-square test (χ2) or Fisher's exact test” were performed and variables with p <0.2 were included in the multivariate logistic regression analysis. Results: Of the total number of patients, 541 (44.5%) had altered estimated Glomerular Filtration Rate, 943 (77.5%) used polypharmacy and 588 (48.3%) used Potentially Inappropriate Medicines for the elderly. Multivariate analysis showed that men over 80 years of age are more likely to have their estimated Glomerular Filtration Rate altered and that the practice of polypharmacy increased the chances of alterations in this parameter by 1.62 (p = 0.004; OR: 1.62; CI: 1, 67 - 2.24). In addition, the use of Potentially Inappropriate Medicines increased the chances of having the estimated Glomerular Filtration Rate altered by 1.49 times (p = 0.003 OR: 1.49; CI: 1.15 - 1.93). Conclusion: This study showed a high frequency of using of polypharmacy and Potentially Inappropriate Medicines in the elderly and this population was shown to have a greater chance of impairing renal functions. Thus, this finding brings an alert to public health and points to the necessity to invest in a therapeutic approach as a focus on the safety of elderly patients.
American Geriatrics Society (AGS). (2019). Updated AGS Beers Criteria® for Potentially Inappropriate Medication use in older adults. Journal of the American Geriatrics Society, 67(4), 674–694. https://doi.org/10.1111/jgs.15767
Araújo, L. U., Santos, D. F., Bodevan, E. C., Cruz, H. L. da, Souza, J. de, & Silva-Barcellos, N. M. (2019). Patient safety in primary health care and polypharmacy: cross-sectional survey among patients with chronic diseases. Revista Latino-Americana de Enfermagem, 27, e3217. https://doi.org/10.1590/1518-8345.3123.3217
Arrabal Júnior, J. M., & Salvi, J. D. O. (2018). Fatores associados à automedicação em uma farmácia comunitária de Ouro Preto Do Oeste, Rondônia. Acta Biomédica Brasiliensia, 9(2), 107. https://doi.org/10.18571/acbm.177
Baldoni, A. D. O., Ayres, L. R., Martinez, E. Z., Dewulf, N. D. L. S., Dos Santos, V., & Pereira, L. R. L. (2014). Factors associated with potentially inappropriate medications use by the elderly according to Beers criteria 2003 and 2012. International Journal of Clinical Pharmacy, 36(2), 316–324. https://doi.org/10.1007/s11096-013-9880-y
Botton, A., Cúnico, S. D. & Strey, M. N. (2017). Diferenças de gênero no acesso aos serviços de saúde: problematizações necessárias. Revista Mudança – Psicologia e saúde, 25(1), 67 – 72. https://www.metodista.br/revistas/revistas-metodista/index.php/MUD/article/view/7009/5608
Bourgeois, J., Elseviers, M. M., Bortel, L. V., Petrovic, M. & Stichele, R. H. V. (2014). Feasibility of discontinuing chronic benzodiazepine use in nursing home residents: a pilot study. European Journal of Clinical Pharmacology, 70, 1251–1260. DOI 10.1007/s00228-014-1725-7
Brasil. (2014). Ministério da Saúde. Secretaria de Ciência, Tecnologia e Insumos Estratégicos. Departamento de Assistência Farmacêutica e Insumos Estratégicos. Cuidado Farmacêutico na Atenção Básica - Caderno 2: Capacitação para implantação dos serviços de clínica farmacêutica. ISBN 978-85-334-2198-1. Brasília, DF. http://bvsms.saude.gov.br/bvs/publicacoes/cuidado_farmaceutico_atencao_basica_saude_2.pdf
Carrero, J. J., Hecking, M., Chesnaye, N. C., & Jager, K. J. (2018). Sex and gender disparities in the epidemiology and outcomes of chronic kidney disease. Nature Reviews Nephrology, 14(3), 151–164. https://doi.org/10.1038/nrneph.2017.181
do Nascimento, M. M. G., Mambrini, J. V. de M., Lima-Costa, M. F., Firmo, J. O. A., Peixoto, S. W. V., & de Loyola Filho, A. I. (2017). Potentially inappropriate medications: predictor for mortality in a cohort of community-dwelling older adults. European Journal of Clinical Pharmacology, 73(5), 615–621. https://doi.org/10.1007/s00228-017-2202-x
Donnelly, K., Bracchi, R., Hewitt, J., Routlede, B. C. (2017). Benzodiazepines, Z-drugs and the risc of hip fracture: A systematic review and meta-analysis. Plos One,12(4), e0174730. https://doi.org/10.1371/journal.pone.0174730
Fundação Getúlio Vargas (FGV). (2020). Social – Centro de Políticas Sociais. Mapas – Idosos. https://cps.fgv.br/mapas-idosos-elderly-maps
International Society of Nephrology (ISN). (2013). Kidney Internacional Suplements. Kidney Disease: Improving Global Outcomes (KDIGO) 2013. Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Official Journal of the International Society of Nephrology, 3, 1–150. https://kdigo.org/wp-content/uploads/2017/02/KDIGO_2012_CKD_GL.pdf
König, M., Gollasch, M., Demuth, I., & Steinhagen-Thiessen, E. (2017). Prevalence of Impaired Kidney Function in the German Elderly: Results from the Berlin Aging Study II (BASE-II). Gerontology, 63(3), 201–209. https://doi.org/10.1159/000454831
Lassiter, J., Bennett, W. M., & Olyaei, A. J. (2013). Drug Dosing in Elderly Patients with Chronic Kidney Disease. Clinics in Geriatric Medicine, 29(3), 657–705. https://doi.org/10.1016/j.cger.2013.05.008
Malta, D. C., Bernal, R. T. I., Lima, M. G., de Araújo, S. S. C., da Silva, M. M. A., Freitas, M. I. de F., & Barros, M. B. de A. (2017). Noncommunicable diseases and the use of health services: Analysis of the National Health Survey in Brazil. Revista de Saúde Pública, 51, 1S-10S. https://doi.org/10.1590/S1518-8787.2017051000090
Musso, C. G., Belloso, W. H., Scibona, P., Bellizzi, V., & Macías Núñez, J. F. (2015). Impact of renal aging on drug therapy. Postgraduate Medicine, 127(6), 623–629. https://doi.org/10.1080/00325481.2015.1063957
Oliveira, M. G., Amorrim, W. W., Oliveira, C. R. B., Coqueiro, H. L., Gusmão, L. C. & Passos, L. C. (2016). Consenso brasileiro de medicamentos potencialmente inapropriados para idosos. Geriatrics, Gerontology and Aging, 10(4), 168-181. https://cdn.publisher.gn1.link/ggaging.com/pdf/v10n4a02.pdf
Organização Pan-Americana de Saúde (OPAS). (2018). Folha Informativa – Envelhecimento e Saúde. World Health Organisation (pp. 1–6). https://www.paho.org/bra/index.php?option=com_content&view=article&id=5661:folha-informativa-envelhecimento-e-saude&Itemid=820
Palacios, C. R. F., Haugen, E. N., Rasmussen, R. W., & Thompson, A. M. (2015). Avoidance of polypharmacy and excessive blood pressure control is associated with improved renal function in older patients. Renal Failure, 37(6), 961–965. https://doi.org/10.3109/0886022X.2015.1044399
Reev, E., Ong, M., Wu, A., Jansen, J., Petrovic, M. & Gnjindic, D. (2017). A systematic review of interventions to deprescribe benzodiazepines and other hypnotics among older people. European Journal Clinical Pharmacology. DOI: 10.1007/s00228-017-2257-8
Rocha, R. S., Silva, L. G. da, Fernandes, M. R., Figueiredo, R. C. de, & Baldoni, A. de O. (2020). Potenciais interações medicamentosas e medicamentos inapropriados prescritos para usuários da atenção primária à saúde. Revista Brasileira de Farmácia Hospitalar e Serviço de Saúde, 11(2), 1–6. https://doi.org/10.30968/rbfhss.2020.112.0365.RBFHSS
Secora, A., Alexander, C., Ballew, S., Coresh, J., & Grams, M. (2019). Inappropriate Medication Use in a Community-Based cohort of older adults. Drugs and Aging, 35(8), 735–750. https://doi.org/10.1007/s40266-018-0563-1.KIDNEY
Shi, S., & Klotz, U. (2011). Age-related changes in pharmacokinetics. Current Drug Metabolism, 12, 601–610. https://doi.org/10.1016/S1543-5946(05)00005-X
Silva, J. M., Mendonça, P. P. & Partata, A. K. (2014). Anti-inflamatórios não-esteróides e suas propriedades gerais. Revista Científica do ITPAC, 7(4). https://assets.unitpac.com.br/arquivos/Revista/74/artigo5.pdf
Stader, F., Siccardi, M., Battegay, M., Kinvig, H., Penny, M. A., & Marzolini, C. (2019). Repository Describing an Aging Population to Inform Physiologically Based Pharmacokinetic Models Considering Anatomical, Physiological, and Biological Age-Dependent Changes. Clinical Pharmacokinetics, 58(4), 483–501. https://doi.org/10.1007/s40262-018-0709-7
Ungprasert, P., Cheungpasitpom, W, Crowson, C. S. & Matteson, E. I. (2015). Individual non-steroidal anti-inflamatory drugs andrisko facute kidney injury: a systematic review and meta-analysis of observational studies. European Journal of Internal Medicine, 26(4), 285-91. DOI: 10.1016/j.ejim.2015.03.008
World Health Organization (WHO). (2016). Multisectoral action for a life course approach to healthy ageing: Draft global strategy and plan of action on ageing and health. In Sixty-ninth World Health Assembly (Issue 22 April). https://apps.who.int/gb/ebwha/pdf_files/WHA69/A69_17-en.pdf
World Health Organization (WHO). (2020). Anatomic Therapeutic Chemical (ATC). WHO Collaborating Centr for Drug Statistics Methodology Norwegian Institute of Public Health. Oslo, Norway. https://www.whocc.no/atc_ddd_index/
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Copyright (c) 2021 Diego Bruno Morais; João Pedro Vasconcelos Paolinelli; Soraia de Freitas Tavares Dâmaso; André Oliveira Baldoni; Alba Otoni
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