[Prevention of adverse events through renal dosage adjustment in institutionalized elders]. / Prevención de acontecimientos adversos mediante ajuste posológico renal en pacientes ancianos institucionalizados.

INTRODUCTION: To present a protocol based on renal dosage adjustment developed to reduce the risk of adverse events in elderly people institutionalized in a geriatric centre and to determine the degree of adaptation to this protocol. MATERIAL AND METHOD: First, we designed a renal adjustment protocol to identify residents with creatinine clearance below 60ml/min, review drug therapy and optimize dosage regimens, if necessary. Then, we evaluated the feasibility of this protocol and adaptation of clinical practice to this protocol through a cross-sectional study of all the residents in the centre. RESULTS: Among the 163 residents assessed by Cockroft-Gault, there were 126 residents with creatinine clearance below 60ml/min (77%; 95% CI, 70-83). Seventeen residents were excluded due to intake of protein supplements or to extreme body mass index. Once the treatments were reviewed, 152/876 (17%; 95% CI, 15-20) prescriptions suitable for renal adjustment were found. In 135/152 prescriptions (89%; 95% CI, 83-93) the dosage was appropriate to creatinine clearance and 17 (11%; 95% CI, 6-17) were considered as potentially optimizable. For these 17 prescriptions, a proposal for dosage adjustment or monitoring was made, which was accepted in 16 cases and rejected in 1 case (metformin in a patient with 44ml/min creatinine clearance and poor glycemic control). CONCLUSIONS: A high percentage of the institutionalized elderly have a creatinine clearance below 60ml/min. Given that a not inconsiderable proportion of their prescribed medication is susceptible to renal adjustment, the implementation of a protocol for renal adjustment and renal function follow-up could help to reduce the risk of adverse events.

Prevención de acontecimientos adversos mediante ajuste posológico renal en pacientes ancianos institucionalizados / Prevention of adverse events through renal dosage adjustment in institutionalized elders

Introducciónpresentar un protocolo de ajuste posológico renal desarrollado para reducir el riesgo de acontecimientos adversos en ancianos institucionalizados en un centro de mayores. Estimar el grado de adecuación actual a ese protocolo.Material y métodosse redactó un protocolo para identificar a los residentes con aclaramiento de creatinina<60ml/min, revisar su farmacoterapia y optimizar la posología si fuera necesario. Se evaluó su factibilidad y la adecuación de la práctica actual al protocolo mediante su aplicación transversal en la totalidad de residentes.Resultadosse identificó a 126 residentes con aclaramiento de creatinina<60ml/min entre los 163 evaluables por Cockroft-Gault (77%; intervalo de confianza [IC] del 95%, 70–83), 17 residentes fueron excluidos por recibir suplementos proteicos o tener índices extremos de masa corporal. Revisados sus tratamientos, se localizaron 152/876 líneas de tratamiento susceptibles de ajuste posológico (17%; IC del 95%, 15–20). En 135/152 (89%; IC del 95%, 83–93) la posología era adecuada al aclaramiento de creatinina y en 17 (11%; IC del 95%, 6–17) se consideró potencialmente optimizable y se realizó la correspondiente propuesta de ajuste o monitorización, que fue aceptada en 16 ocasiones y desestimada en una (metformina en paciente con aclaramiento de 44ml/min y mal control glucémico).Conclusionesun elevado porcentaje de los ancianos institucionalizados presenta aclaramiento de creatinina<60ml/min. Dado que una parte no despreciable de su medicación es susceptible de ajuste renal, establecer un protocolo de optimización de la posología y de control de la función renal contribuirá a reducir el riesgo de efectos adversos por medicamentos en este grupo de población (AU)

IntroductionTo present a protocol based on renal dosage adjustment developed to reduce the risk of adverse events in elderly people institutionalized in a geriatric centre and to determine the degree of adaptation to this protocol.Material and methodFirst, we designed a renal adjustment protocol to identify residents with creatinine clearance below 60ml/min, review drug therapy and optimize dosage regimens, if necessary. Then, we evaluated the feasibility of this protocol and adaptation of clinical practice to this protocol through a cross-sectional study of all the residents in the centre.ResultsAmong the 163 residents assessed by Cockroft-Gault, there were 126 residents with creatinine clearance below 60ml/min (77%; 95% CI, 70–83). Seventeen residents were excluded due to intake of protein supplements or to extreme body mass index. Once the treatments were reviewed, 152/876 (17%; 95% CI, 15–20) prescriptions suitable for renal adjustment were found. In 135/152 prescriptions (89%; 95% CI, 83–93) the dosage was appropriate to creatinine clearance and 17 (11%; 95% CI, 6–17) were considered as potentially optimizable. For these 17 prescriptions, a proposal for dosage adjustment or monitoring was made, which was accepted in 16 cases and rejected in 1 case (metformin in a patient with 44ml/min creatinine clearance and poor glycemic control).ConclusionsA high percentage of the institutionalized elderly have a creatinine clearance below 60ml/min. Given that a not inconsiderable proportion of their prescribed medication is susceptible to renal adjustment, the implementation of a protocol for renal adjustment and renal function follow-up could help to reduce the risk of adverse events (AU)