1 Introduction
The populations of most high-income countries are slowly
growing. In particular, the number and proportion of older
people is increasing rapidly. The renal function (glomerular
filtration rate, GFR) decreases, whereas the average number
of prescribed pharmaceutical drugs increases with age.
Figure 1 presents the average kidney function GFR,
expressed in mL/min/1.73 m2
, and the prevalence of
reduced kidney function (GFR 60 mL/min/1.73 m2
) in
different age categories in Sweden. In the figure, there is
also the average number of prescribed medications in the
same age groups. As about 60 % of all registered medicines
are mainly excreted via the kidneys [1], there is an
apparent risk of overdosing in the elderly with lowered
renal function. This has also repeatedly been observed in
clinical studies. In a Norwegian study [2], prescriptions for
808 patients who had been admitted to departments of
internal medicine and rheumatology in five general hospitals
were examined. Estimated GFR (eGFR) was calculated
for each patient from plasma creatinine and put in relation
to the current pharmaceutical prescription before and during
the treatment period. Prescription of drugs that were
judged to be inappropriate by the lowered kidney function
was highly prevalent. Sixty-two percent of the patients with
eGFR 60 mL/min/1.73 m2 were judged to have drugrelated
problems linked to ‘renal-risk drugs’ and 26 % of
the prescribed renal-risk drugs were associated with at least
one drug-related problem. The lower the eGFR and the
higher the age, the greater was the risk of error and damage.
Similar observations have been made in an Italian
study [3] of 10,422 elderly hospitalized patients and in a
study of 109,641 US patients [4], of whom 17,614 were
found to have reduced creatinine clearance. In a random
sample of 900 of these patients, there were 498 potential
1 IntroductionThe populations of most high-income countries are slowlygrowing. In particular, the number and proportion of olderpeople is increasing rapidly. The renal function (glomerularfiltration rate, GFR) decreases, whereas the average numberof prescribed pharmaceutical drugs increases with age.Figure 1 presents the average kidney function GFR,expressed in mL/min/1.73 m2, and the prevalence ofreduced kidney function (GFR 60 mL/min/1.73 m2) indifferent age categories in Sweden. In the figure, there isalso the average number of prescribed medications in thesame age groups. As about 60 % of all registered medicinesare mainly excreted via the kidneys [1], there is anapparent risk of overdosing in the elderly with loweredrenal function. This has also repeatedly been observed inclinical studies. In a Norwegian study [2], prescriptions for808 patients who had been admitted to departments ofinternal medicine and rheumatology in five general hospitalswere examined. Estimated GFR (eGFR) was calculatedfor each patient from plasma creatinine and put in relationto the current pharmaceutical prescription before and duringthe treatment period. Prescription of drugs that werejudged to be inappropriate by the lowered kidney functionwas highly prevalent. Sixty-two percent of the patients witheGFR 60 mL/min/1.73 m2 were judged to have drugrelatedproblems linked to ‘renal-risk drugs’ and 26 % ofยาไตความเสี่ยงกำหนดมีสัมพันธ์กับน้อยปัญหาที่เกี่ยวข้องกับยาเสพติดหนึ่ง EGFR ต่ำและสูงอายุ ยิ่งมีความเสี่ยงในการผิดพลาดและความเสียหายได้ทำการสังเกตที่คล้ายกันในภาษาอิตาลีศึกษา [3] ผู้ป่วยพี่จึ 10,422 ผู้สูงอายุ และในการศึกษาของ 109,641 เราคน 17,614 ถูกผู้ป่วย [4],พบว่าการตรวจ creatinine ลดลง ในการสุ่มตัวอย่าง 900 ผู้ป่วยเหล่านี้ มี 498 ศักยภาพ
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