Prescription of potentially inappropriate medications to elderly hemodialysis patients: prevalence and predictors.
BACKGROUND
In elderly hemodialysis (HD) patients, the risk of medication-related problems is particularly high. Thus, certain medications should generally not be prescribed to those patients. The Beers criteria for potentially inappropriate medications (PIMs) have been publicized. Still, with regard to elderly HD patients, the prevalence and risk factors for prescription of PIMs are unknown.


METHODS
This was a cross-sectional study of data from the Japan Dialysis Outcomes and Practice Patterns Study (2002-08). Patients were included if they were 65 years old or older and were currently receiving HD treatment at a hospital or clinic. We counted the number of patients who were prescribed at least one PIM, as defined by the modified Beers criteria. We used multiple logistic regression analysis to determine which patient characteristics and facility characteristics were associated with prescription of PIMs.


RESULTS
Data from 1367 elderly patients were analyzed. More than half of the patients (57%) had been prescribed a PIM. The three most frequently prescribed PIMs were H2 blockers (33%), antiplatelet agents (19%) and α-blockers (13%). PIM prescriptions were less likely at facilities that conducted multidisciplinary rounds {adjusted odds ratio (AOR): 0.67 [95% confidence interval (CI): 0.48-0.93]} and at teaching hospitals [AOR: 0.59 (95% CI, 0.39-0.90)]. PIM prescriptions are more likely if more than one physician has clearance to alter the HD regimen [AOR: 1.65 (95% CI, 1.12-2.44)].


CONCLUSIONS
PIMs were prescribed to many elderly HD patients in Japan. Nephrologists should become more aware of PIMs. Multidisciplinary rounds could benefit patients by reducing the prescription of PIMs.
Department of Healthcare Epidemiology, Kyoto University Graduate School of Medicine and Public Health, Kyoto, Japan.
Naoya
N
Kondo
Department of Public Health, The University of Tokyo Graduate School of Medicine, Tokyo, Japan.
Fumiaki
F
Nakamura
Department of Healthcare Epidemiology, Kyoto University Graduate School of Medicine and Public Health, Kyoto, Japan.
Shin
S
Yamazaki
Department of Healthcare Epidemiology, Kyoto University Graduate School of Medicine and Public Health, Kyoto, Japan.
Yosuke
Y
Yamamoto
Division of Nephrology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan.
Tadao
T
Akizawa
Department of Blood Purification and Internal Medicine, Kidney Center, Tokyo Women's Medical University, Tokyo, Japan.
Takashi
T
Akiba
Division of Nephrology and Metabolism, Department of Medicine, Tokai University School of Medicine, Kanagawa, Japan.
Akira
A
Saito
National Graduate Institute for Policy Studies, Tokyo, Japan.
Kiyoshi
K
Kurokawa
Department of Healthcare Epidemiology, Kyoto University Graduate School of Medicine and Public Health, Kyoto, Japan Center for Innovative Research in Clinical Evaluative Science, Fukushima Medical University, Fukushima, Japan Institute for Health Outcomes and Process Evaluation Research, Tokyo, Japan.
Shunichi
S
Fukuhara
D000368:Aged; D000369:Aged, 80 and over; D000554:Ambulatory Care Facilities; D017322:Clinical Trials, Phase II as Topic; D017326:Clinical Trials, Phase III as Topic; D003430:Cross-Sectional Studies; D004358:Drug Therapy / Q000592:standards*; D004363:Drug Utilization / Q000706:statistics & numerical data*; D005260:Female; D005853:Geriatrics; D006760:Hospitalization; D006784:Hospitals, Teaching / Q000458:organization & administration*; D006801:Humans; D057970:Inappropriate Prescribing / Q000706:statistics & numerical data*; D007564:Japan; D008297:Male; D000067561:Potentially Inappropriate Medication List; D010818:Practice Patterns, Physicians'; D015995:Prevalence; D006435:Renal Dialysis; D012307:Risk Factors
DOPPS; adverse drug events; elderly patients; hemodialysis; potentially inappropriate medication