title: Inappropriate drug use and mortality in community-dwelling elderly with impaired kidney function--the Three-City population-based study.
abstract: BACKGROUND
  Glomerular filtration rate (GFR) decline with age increases the risk of inappropriate dosing of drugs. We investigated the determinants and the mortality associated with the use of drugs that are contraindicated or require dose adjustment according to kidney function among the community-dwelling elderly.
  
  
  METHODS
  The Three-City population-based study included 8701 participants ≥65 years from 1999 to 2001. Exposure to the risk of inappropriate drug dosage was defined as reported use of either a contraindicated drug or one requiring dose adjustment according to the individual baseline glomerular filtration rate estimated (eGFR) with the Modification of Diet in Renal disease study equation. Six-year mortality was analysed using Cox models adjusted for several sociodemographic, biologic and clinical risk factors.
  
  
  RESULTS
  The overall percentage of exposure to the risk of inappropriate drug use was 13.3% (contraindication, 0.8%): it was 52.5% (4.5%) in those with an eGFR of 30-59 and 96% (48%) in those <30 mL/min/1.73 m(2). Antihypertensive agents, fibrates and psycholeptics accounted for most of the drugs with dosing recommendations and antidiabetic agents and antihistamines for those contraindicated. Individuals at risk were more likely to be men, older, and under treatment for hypertension or hypercholesterolemia. Exposure to either risk was independently related to higher all-cause mortality (hazard ratio 1.4, 95% confidence interval 1.0-1.9) in participants with eGFR <60 mL/min/1.73 m(2).
  
  
  CONCLUSIONS
  Contraindicated drug prescription was uncommon but >10% of the population took drugs requiring renal dosing adjustments. Regular monitoring of eGFR may prevent excess mortality associated with inappropriate drug prescription in the elderly.
authors.affiliation: Inserm, Centre for research in Epidemiology and Population Health, U1018, Villejuif, France.
authors.forename: Gaëlle
authors.initials: G
authors.lastname: Breton
authors.forename: Marc
authors.initials: M
authors.lastname: Froissart
authors.forename: Nicolas
authors.initials: N
authors.lastname: Janus
authors.forename: Vincent
authors.initials: V
authors.lastname: Launay-Vacher
authors.forename: Claudine
authors.initials: C
authors.lastname: Berr
authors.forename: Christophe
authors.initials: C
authors.lastname: Tzourio
authors.forename: Catherine
authors.initials: C
authors.lastname: Helmer
authors.forename: Benedicte
authors.initials: B
authors.lastname: Stengel
mesh_terms: D000368:Aged; D015331:Cohort Studies; D018672:Community Health Planning; D064420:Drug-Related Side Effects and Adverse Reactions; D005260:Female; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D005919:Glomerular Filtration Rate; D006801:Humans; D057970:Inappropriate Prescribing / Q000009:adverse effects*; D007668:Kidney / Q000503:physiopathology*; D007676:Kidney Failure, Chronic / Q000453:epidemiology / Q000401:mortality* / Q000473:pathology*; D007677:Kidney Function Tests; D008137:Longitudinal Studies; D008297:Male; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D015996:Survival Rate