title: Inappropriate Medication in Non-Hospitalized Patients With Renal Insufficiency: A Systematic Review.
abstract: OBJECTIVE
  Renal insufficiency is common among older patients and, accordingly, renally excreted drugs may require an adjustment in dosage for them. Rates of non-adherence to renal dosing guidelines range from 19% to 70% across all settings, with the highest rate occurring in outpatient care. However, there is a paucity of research in this field. The main objective of this systematic review is to assess how often drugs are inappropriately prescribed in non-hospitalized patients with renal insufficiency.
  
  
  METHODS
  A systematic literature search was performed. Data were identified from three electronic databases: PubMed, CINAHL, and Scopus. Studies were included if they reported quantitative data on inappropriate drug use with respect to renal function in non-hospitalized patients.
  
  
  RESULTS
  Our search strategy resulted in 2,403 hits, of which 18 articles satisfied the criteria for inclusion. Mean estimated glomerular filtration rate ranged from 36.0 to 60.4 mL/min. Prevalence of renally inappropriate drug use ranged from 1% to 37% in outpatient settings other than nursing homes, and from 6% to 43% in nursing homes. Eight of the studies we included identified predictors for use of drugs inappropriate for kidney function. Most frequently determined risk factors were increasing age and a high number of prescribed drugs.
  
  
  CONCLUSIONS
  Lack of dose adjustment for renal impairment seems to be a common problem, even in outpatients. However, the differences in methodologies used in these studies hampered any direct comparison. Accepted and comparable standards regarding the drugs included in the studies as well as estimation of renal function would be beneficial.
authors.affiliation: Department of Health Services Research, Carl von Ossietzky University Oldenburg, Oldenburg, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Dörks
authors.affiliation: Department of Health Services Research, Carl von Ossietzky University Oldenburg, Oldenburg, Germany.
authors.forename: Katharina
authors.initials: K
authors.lastname: Allers
authors.affiliation: Institute for Public Health and Nursing Science, Department for Health Services Research, University of Bremen, Bremen, Germany.|Health Sciences, University of Bremen, Bremen, Germany.
authors.forename: Guido
authors.initials: G
authors.lastname: Schmiemann
authors.affiliation: Department of Medicine, Rotes Kreuz Krankenhaus, Bremen, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Herget-Rosenthal
authors.affiliation: Department of Health Services Research, Carl von Ossietzky University Oldenburg, Oldenburg, Germany.
authors.forename: Falk
authors.initials: F
authors.lastname: Hoffmann
mesh_terms: D000368:Aged; D005919:Glomerular Filtration Rate; D006801:Humans; D057970:Inappropriate Prescribing; D055553:Prescription Drugs / Q000493:pharmacokinetics*; D051437:Renal Insufficiency / Q000378:metabolism*; D012307:Risk Factors
chemical_list: D055553:Prescription Drugs
keywords: dose adjustment; inappropriate medication; nursing home; outpatients; renal insufficiency