Influence of polypharmacy and use of inappropriate medication for the elderly on the glomerular filtration rate

Authors

DOI:

https://doi.org/10.33448/rsd-v10i4.14239

Keywords:

Glomerular filtration rate; Polypharmacy; Potentially inappropriate medication; Aged.

Abstract

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.

References

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/

Published

04/04/2021

How to Cite

MORAIS, D. B.; PAOLINELLI, J. P. V.; DÂMASO, S. de F. T.; BALDONI, A. O.; OTONI, A. Influence of polypharmacy and use of inappropriate medication for the elderly on the glomerular filtration rate. Research, Society and Development, [S. l.], v. 10, n. 4, p. e31810414239, 2021. DOI: 10.33448/rsd-v10i4.14239. Disponível em: https://rsdjournal.org/index.php/rsd/article/view/14239. Acesso em: 16 nov. 2024.

Issue

Section

Health Sciences