title: Renal Insufficiency and Medication in Nursing Home Residents. A Cross-Sectional Study (IMREN).
abstract: BACKGROUND
  Nursing home residents often suffer from a multiplicity of medical conditions and take many different drugs. Many drugs are eliminated via the kidneys and thus require dose adjustment in patients with renal insufficiency. This is the first study to address the prevalence of renal insufficiency among nursing home residents in Germany, and the extent to which such persons take drugs that are contraindicated or incorrectly dosed because of renal insufficiency.
  
  
  METHODS
  We carried out a cross-sectional study in nursing homes in the German regions of Bremen and Lower Saxony. Data were collected by nursing staff and given to us anonymously. Whenever the nursing home data did not include a current creatinine value, the patient's general practitioner was asked to supply this value. The estimated creatinine clearance (eCCr) was calculated with the Cockcroft-Gault formula.
  
  
  RESULTS
  852 residents of 21 nursing homes were included in the study; eCCr values were obtainable for 685 (80.4%) of them (average age, 83.3 years; 75.2% female). 48.2% of these patients (95% confidence interval [CI] 41.8-54.5) had moderate renal insufficiency (eCCr 59-30 mL/min), and 15.5% (95% CI 12.4-18.6) had severe renal insufficiency (eCCr <30 mL/min). 19.7% were regularly taking at least one medication that was contraindicated or incorrectly dosed in the light of renal insufficiency. Predictors for such inappropriate drug use were advanced age, female sex, arterial hypertension, and polypharmacy. The drugs that were most often inappropriately used were metformin, ramipril, and potassium chloride.
  
  
  CONCLUSIONS
  Nursing home residents often suffer from renal insufficiency and should therefore have their creatinine levels measured regularly. A knowledge of the creatinine level is a prerequisite for the proper adjustment of drug doses (if necessary). A practical and compact summary of dose-adjustment recommendations for patients with renal insufficiency would be desirable but is not yet available.
authors.affiliation: Department of Health Services Research, Medicine and Health Sciences, Carl von Ossietzky Universität Oldenburg, Medical Clinic, Rotes-Kreuz-Krankenhaus, Bremen, Department of Health, Nursing and Age Studies, SOCIUM - Research Center on Inequality and Social Policy, University of Bremen, Department for Health Services Research, Institute for Public Health and Nursing Research, University of Bremen and Health Sciences Bremen.
authors.forename: Falk
authors.initials: F
authors.lastname: Hoffmann
authors.forename: Daniela
authors.initials: D
authors.lastname: Boeschen
authors.forename: Michael
authors.initials: M
authors.lastname: Dörks
authors.forename: Stefan
authors.initials: S
authors.lastname: Herget-Rosenthal
authors.forename: Jana
authors.initials: J
authors.lastname: Petersen
authors.forename: Guido
authors.initials: G
authors.lastname: Schmiemann
mesh_terms: D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D004363:Drug Utilization / Q000706:statistics & numerical data; D005260:Female; D005858:Germany / Q000453:epidemiology; D006707:Homes for the Aged / Q000706:statistics & numerical data*; D006801:Humans; D006973:Hypertension / Q000453:epidemiology*; D057970:Inappropriate Prescribing / Q000706:statistics & numerical data*; D008297:Male; D009735:Nursing Homes / Q000706:statistics & numerical data*; D019338:Polypharmacy; D015995:Prevalence; D011379:Prognosis; D051436:Renal Insufficiency, Chronic / Q000188:drug therapy* / Q000453:epidemiology*; D012307:Risk Factors; D017678:Sex Distribution