title: Avoidance of polypharmacy and excessive blood pressure control is associated with improved renal function in older patients.
abstract: BACKGROUND
  Elderly patients are particularly susceptible to polypharmacy. The present study evaluated the renal effects of optimizing potentially nephrotoxic medications in an older population.
  
  
  METHODS
  Retrospective study of patients' ≥ 60 years treated between January of 2013 and February of 2015 in a Nephrology Clinic. The renal effect of avoiding polypharmacy was studied.
  
  
  RESULTS
  Sixty-one patients were studied. Median age was 81 years (range 60-94). Twenty-five patients (41%) were male. NSAIDs alone were stopped in seven patients (11.4%), a dose reduction in antihypertensives was done in 11 patients (18%), one or more antihypertensives were discontinued in 20 patients (32.7%) and discontinuation and dose reduction of multiple medications was carried out in 23 patients (37.7%). The number of antihypertensives was reduced from a median of 3 (range of 0-8) at baseline to a median of 2 (range 0-7), p < 0.001 after intervention. After intervention, the glomerular filtration rate (GFR) improved significantly, from a baseline of 32 ± 15.5 cc/min/1.73 m(2) to 39.5 ± 17 cc/min/1.73 m(2) at t1 (p < 0.001) and 44.5 ± 18.7 cc/min/1.73 m(2) at t2 (p < 0.001 vs. baseline). In a multivariate model, after adjusting for ACEIs/ARBs discontinuation/dose reduction, NSAIDs use and change in DBP, an increase in SBP at time 1 remained significantly associated with increments in GFR on follow-up (estimate = 0.20, p = 0.01).
  
  
  CONCLUSIONS
  Avoidance of polypharmacy was associated with an improvement in renal function.
authors.affiliation: a Nephrology Department , Affiliated Community Medical Centers, Rice Memorial Hospital , Willmar , MN , USA and.
authors.forename: Carlos R
authors.initials: CR
authors.lastname: Franco Palacios
authors.affiliation: a Nephrology Department , Affiliated Community Medical Centers, Rice Memorial Hospital , Willmar , MN , USA and.
authors.forename: Eric N
authors.initials: EN
authors.lastname: Haugen
authors.affiliation: a Nephrology Department , Affiliated Community Medical Centers, Rice Memorial Hospital , Willmar , MN , USA and.
authors.forename: Richard W
authors.initials: RW
authors.lastname: Rasmussen
authors.affiliation: b Pharmacy Department , Rice Memorial Hospital , Willmar , MN , USA.
authors.forename: Amanda M
authors.initials: AM
authors.lastname: Thompson
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000187:drug effects* / Q000502:physiology; D000959:Antihypertensive Agents / Q000009:adverse effects* / Q000627:therapeutic use; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D015577:Geriatric Assessment; D005919:Glomerular Filtration Rate / Q000187:drug effects*; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000188:drug therapy*; D007668:Kidney / Q000187:drug effects; D007677:Kidney Function Tests; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D020380:Needs Assessment; D019338:Polypharmacy; D057285:Precision Medicine; D012189:Retrospective Studies; D018570:Risk Assessment
chemical_list: D000959:Antihypertensive Agents
keywords: Polypharmacy; blood pressure; elderly; renal function