Gastrointestinal disease control after histamine2-receptor antagonist dose modification for renal impairment in frail chronically ill elderly patients.
OBJECTIVE
To determine whether histamine2-receptor antagonist (H2RA) dose modified for renal impairment affects gastrointestinal (GI) disease control.


METHODS
Concurrent medical record review.


METHODS
One hundred forty-six nursing facilities throughout the United States.


METHODS
Three hundred thirty-six patients aged 65 and older receiving H2RAs for GI disorders.


METHODS
H2RA dose modified for renal impairment or no dose change.


METHODS
Disease control (no H2RA dose increase for 6 months or longer, additional GI medication, hospitalizations, emergency room visits, and unscheduled physician visits for GI symptoms) was evaluated using chart review at 3, 6, 9, and 12 months in nursing home patients aged 65 and older with H2RA dose modified for decreased creatinine clearance (ClCr) according to manufacturer.


RESULTS
Three hundred thirty-six patients, mean age +/- standard deviation 85.9 +/- 7.9, with mean ClCr of 33.6 +/- 10.4 mL/min, were recommended to receive lower H2RA doses based upon estimated renal function. Patients were analyzed in two groups: H2RA dose reduced (Group 1) and dose reduction not adopted or implemented (Group 2). There was no difference in baseline characteristics (age, weight, ClCr, or starting H2RA dose and indication) between the two groups. One hundred ninety-eight patients in Group 1 were taking 195.5 +/- 71.0 mg per day of nizatidine or equivalent, compared with 183.7 +/- 66.6 mg for 138 patients in Group 2. For patients with 90 days of follow-up, the mean H2RA dose in Group 1 was 100.2 +/- 44.3 mg, compared with 187.8 +/- 69.9 for Group 2 (P <.0001) The mean decrease in daily dose for Groups 1 and 2 after 365 days were 98.9 +/- 72.9 mg and 22.2 +/- 68.2 mg, respectively (P <.0001). Except for more physician visits in Group 2, disease control was similar for all groups. Major and minor GI bleeding events were similar across both groups and over time. The 12-month mortality rate was 12.1% and 21.7% for Groups 1 and 2, respectively. This difference was statistically significant (P =.02).


CONCLUSIONS
The findings suggest that the dose of H2RAs may be decreased based upon renal function in frail elderly patients without compromising GI disease control.
Lackner
Thomas E
TE
University of Minnesota, College of Pharmacy and Institute for the Study of Geriatric Pharmacotherapy, Minneapolis, USA. lackn001@umn.edu
Heard
Tom
T
Glunz
Samantha
S
Gann
Nicole
N
Babington
Maude
M
Malone
Daniel C
DC
D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D002908:Chronic Disease; D005260:Female; D016330:Frail Elderly; D005767:Gastrointestinal Diseases / Q000188:drug therapy*; D006635:Histamine H2 Antagonists / Q000008:administration & dosage* / Q000493:pharmacokinetics*; D006801:Humans; D008297:Male; D051437:Renal Insufficiency / Q000378:metabolism*; D018709:Statistics, Nonparametric; D016896:Treatment Outcome
D006635:Histamine H2 Antagonists