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Renal impairment and medication: METHODS

This study focused on patients residing in two psychogeriatric wards of a 117-bed psychiatric hospital located in a small urban area of Ontario. One ward is for older adults with dementia (eg, Alzheimer’s disease), the other for older adults with primary psychotic illnesses (eg, schizophrenia). Both wards have a 25-bed capacity. Using chart abstraction, data for all patients residing in both wards in January 2000 were obtained.

Patients’ diagnoses were based on the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) . Renal impairment was defined as SCr levels of 136 pmol/L (1.5 mg/dL) for men and 120 pmol/L (1.4 mg/dL) for women, or a CCr of less than 50 mL/min . CCr was determined with the Cockcroft and Gault equation using SCr levels, actual body weight, age and sex (Appendix 1).

Medications were classified as ‘regular’ or ‘as-needed’. Further, the therapeutic category was determined according to the classification of the American Hospital Formulary Service (AHFS). For cheap medications with dosing guidelines in the event of renal impairment, actual doses given were compared with recommended doses. A summary of recommended dosages as outlined by Papaioannou et al , is presented in Appendix 2.

Descriptive data are presented as means and 95% confidence intervals (CIs), or as numbers and proportions. Correlations were based on the Pearson technique . Reliability was based on the Kappa statistic . The Kappa statistic provides a measure of chance-corrected agreement ranging from -1 to 1; values of 0.6 or greater denote substantial agreement .

Appendix 1: Data from reference 5. CCr Creatinine clearance; SCr Serum creatinine

Figure2Renal impairment and medicatios
Recommended dosage guidelines based on creatinine clearance (mL/min)

Figure3Renal impairment and medicatios
Appendix 2: Data from reference 23. Aluminum hydroxide (Maalox, Novartis Consumer Health, Missisauga)

Category: Psychogeriatric inpatients

Tags: Creatinine clearance, Medication use, Older adults, renal function, Serum creatinine

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