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Renal impairment and medication: RESULTS(2)

Patient data by diagnosis are presented in Table 1. These data suggest that differences in age, weight and renal impairment could be present across diagnostic groups. Patients with organic appeared older, had a lower body mass and were more likely to have renal impairment. Unfortunately, the sample size was too small for formal subgroup analyses.

The average number of regular medications per patient was 6.2 (CI, 5.3 to 7.2; range 0 to 12), the average of as-needed medications was 3.9 (95% CI, 3.2 to 4.6; range 1 to 9). The overall numbers of medications according to specific therapeutic categories are shown in Table 2. Nearly half of all regular medications (48%) were central nervous system medications. Gastrointestinal (20%) and cardiovascular (8%) Canadian medications were distant second and third most-used types of medications.

TABLE 2 Regular and as-needed prescriptions

Therapeutic category Regular (n [%]) As-needed (n [%]) Total (n [%])
Antihistamines 0 1 1
Anti-infectives 1 0 1
Involuntary nervous system 6 9 15
Blood formation and coagulation 3 0 3
Cardiovascular 25 6 31
Central nervous system 107 73 180
Electrolytic, caloric, water balance 11 0 11
Eye, ear, nose, throat 4 0 4
Gastrointestinal 34 41 75
Hormones and synthetic substitutes 22 1 23
Skin and mucous membranes 6 12 18
Smooth muscle relaxants 1 0 1
Vitamins, minerals 8 0 8
Unclassified 3 1 4
Total 231 144 375

medications are shown in Table 3. Of all these prescriptions, only 2 (5%) were inappropriately prescribed, both for the same patient. Metformin required a lower dosage; glyburide required discontinuation.

A total of 23 patients (62%) shared 44 prescriptions for which dosing guidelines are available. The type and number of medications are shown in Table 3. Of all these prescriptions, only 2 (5%) were inappropriately prescribed, both for the same patient. Metformin required a lower dosage; glyburide required discontinuation.

TABLE 3 Appropriateness of prescribing based on creatinine clearance

Medication Number prescribed Inappropriate
Allopurinol 1 0
Atenolol 1 0
Enalapril 6 0
Glyburide 5 1
Hydrochlorothiazide 2 0
Lisinopril 1 0
Maalox* 9 0
Metformin 3 1
Milk of magnesia 9 0
Ranitidine 6 0
Spironolactone 1 0
Total 44 2

*Novartis Consumer Health, Mississauga

Category: Psychogeriatric inpatients

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

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