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. 2023 Feb 8:14:1098465.
doi: 10.3389/fphar.2023.1098465. eCollection 2023.

Potentially inappropriate medication among older patients with diabetic kidney disease

Yuping Wang  1 , Jie Zhu  2   3   4 , Luchen Shan  5 , Ling Wu  1 , Cunchuan Wang  2   3 , Wah Yang  2   3
Affiliations

Potentially inappropriate medication among older patients with diabetic kidney disease

Yuping Wang et al. Front Pharmacol. .

Abstract

Objective: Potentially inappropriate medications (PIM) contribute to poor outcomes in older patients, making it a widespread health problem. The study explored the occurrence and risk factors of PIM in older diabetic kidney disease (DKD) patients during hospitalization and investigated whether polypharmacy was associated with it. Methods: Retrospective analysis of the patients ≥ 65 years old diagnosed with DKD from July to December 2020; the PIM was evaluated according to the American Beers Criteria (2019). Factors with statistical significance in univariate analysis were included in Logistic multivariate analysis to explore the potential risk factors related to PIM. Results: Included 186 patients, 65.6% of patients had PIM, and 300 items were confirmed. The highest incidence of PIM was 41.7% for drugs that should be carefully used by the older, followed by 35.3% that should be avoided during hospitalization. The incidence of PIM related to diseases or symptoms, drug interactions to avoid, and drugs to avoid or reduce dose for renal insufficiency patients were 6.3%, 4.0% and 12.7%, respectively. The medications with a high incidence of PIM were diuretics (35.0%), benzodiazepines (10.7%) and peripheral ɑ1 blockers (8.7%). Compared with hospitalization, there were 26% of patients had increased PIM at discharge. Multivariate Logistic regression analysis showed that polypharmacy during hospitalization was an independent risk factor for PIM, OR = 4.471 (95% CI: 2.378, 8.406). Conclusion: The incidence of PIM in hospitalized older DKD patients is high; we should pay more attention to the problem of polypharmacy in these patients. Pharmacists identifying the subtypes and risk factors for PIM may facilitate risk reduction for older DKD patients.

Keywords: diabetic kidney disease; hospitalised and dicharge patient; older patients; polypharmacy; potentially inappropriate medication.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
The flowchart of this study.
FIGURE 2
FIGURE 2
Number of potentially inappropriate medications per patient.
FIGURE 3
FIGURE 3
Change in the number of PIM between hospitalization and discharge. There were 44% patients had less potentially inappropriate medication (PIM) at discharge than hospitalization, 26% patients had more PIM than hospitalization at discharge; 19% patients had no PIM during hospitalization nor at discharge; 11% had the same PIM at release as in hospitalization.
FIGURE 4
FIGURE 4
Binary logistics regression analysis of factors related to PIM.
See this image and copyright information in PMC

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