title: Diuretic drug therapy monitoring in the elderly: a cohort study.
abstract: BACKGROUND
  Because the elderly are often treated by multiple-drug regimens, their iatrogenic risks are considerably raised. However, despite the serious side-effects that diuretic agents may have in this population, SPCs (summary of product characteristics) do not specify how often serum chemistry should be monitored. This study of long-term diuretic therapy prescription and monitoring in elderly patients was conducted by the Department of Clinical Pharmacology of the Nantes teaching hospital in collaboration with the medical department of the French national health insurance scheme.
  
  
  METHODS
  Data were extracted from the French national health insurance database. Patients were 75 years old or more and had been receiving a diuretic agent for 1 year or longer. The patients were classified into two groups: one group included those patients whose serum chemistry had been monitored at least once (electrolyte levels and/or urea and creatinine blood levels); the other group included the non-monitored patients.
  
  
  RESULTS
  Mean patient age was 80+/-4.6 (SD) years. The non-monitored patients represented 22.8% of the cohort. The at-risk patients were mainly women suffering from no severe disease, treated by a single practitioner (often a general practitioner) and/or always receiving the same type of diuretic agent.
  
  
  CONCLUSIONS
  Many elderly patients receiving diuretic agents do not benefit from regular serum chemistry monitoring. The prescription of serum chemistry assays is correlated to the presence of various patient-related risk factors. Recommendations should be made to help practitioners to ensure a minimal serum chemistry monitoring in all elderly patients receiving diuretics.
authors.affiliation: Service de Pharmacologie Clinique, CHU de Nantes, France. marie.marais@chu-nantes.fr
authors.forename: Marie
authors.initials: M
authors.lastname: Gérardin-Marais
authors.forename: Caroline
authors.initials: C
authors.lastname: Victorri-Vigneau
authors.forename: Gwenaëlle
authors.initials: G
authors.lastname: Allain-Veyrac
authors.forename: Anicet
authors.initials: A
authors.lastname: Chaslerie
authors.forename: Maryse
authors.initials: M
authors.lastname: Nicolas
authors.forename: Nathalie
authors.initials: N
authors.lastname: Sarraf
authors.forename: Jacques
authors.initials: J
authors.lastname: Pivette
authors.forename: Pascale
authors.initials: P
authors.lastname: Jolliet
mesh_terms: D000368:Aged / Q000502:physiology*; D000369:Aged, 80 and over; D015331:Cohort Studies; D016208:Databases, Factual; D004232:Diuretics / Q000008:administration & dosage / Q000627:therapeutic use*; D004347:Drug Interactions; D016903:Drug Monitoring; D011307:Drug Prescriptions; D004359:Drug Therapy, Combination; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D016015:Logistic Models; D008134:Long-Term Care; D008297:Male; D009313:National Health Programs
chemical_list: D004232:Diuretics