[Prevention of adverse events through renal dosage adjustment in institutionalized elders].
BACKGROUND
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.


METHODS
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.
Abajo Del Alamo
Celia
C
Servicio de Farmacia, Hospital Universitario Río Hortega, Valladolid, España. celiabajo@hotmail.com
García Rodicio
Sonsoles
S
Casado Pérez
Jesús
J
Ausín Pérez
María Lourdes
ML
Catalá Pindado
Miguel A
MA
D000368:Aged; D002985:Clinical Protocols; D054796:Drug Dosage Calculations; D016903:Drug Monitoring / Q000379:methods; D006801:Humans; D007326:Institutionalization; D007677:Kidney Function Tests; D012308:Risk Management