The effect of hospitalization on potentially inappropriate medication use in older adults with chronic kidney disease.

OBJECTIVES: Potentially inappropriate medications (PIMs) use is associated with increased morbidity and mortality in chronic kidney disease (CKD). However, there is paucity of data on how hospitalization affects PIMs use in older adults with CKD. Therefore, we aimed to measure the impact of hospitalization on PIMs use in older CKD patients, and identify factors predicting PIMs use.

METHODS: A retrospective cohort study was conducted in older adults (≥ 65 years) with CKD admitted to an Australian tertiary care hospital over a 6-month period. PIMs use was measured, upon admission and at discharge, using the Medication Appropriateness Index (MAI) and Beers criteria (2015 version) for medications recommended to be avoided in older adults and under certain conditions.

RESULTS: The median age of the 204 patients was 83 years (interquartile range (IQR): 76-87 years) and most were men (61%). Overall, the level of PIMs use (MAI) decreased from admission to discharge [median (IQR): 6 (3-12) to 5 (2-9); p < 0.01)]. More than half of the participants (55%) had at least one PIM per Beers criteria on admission, which reduced by discharge (48%; p < 0.01). People admitted with a higher number of medications (β 0.72, 95% CI 0.56 to 0.88) and lower eGFR values (β -0.11, 95% CI -0.18 to -0.04) had higher MAI scores after adjusting for age, sex and Charlson's comorbidity index (CCI).

CONCLUSIONS: PIMs were commonly used in older CKD patients. Hospitalization was associated with a reduction in PIMs use, but there was considerable scope for improvement in these susceptible individuals.