De-Prescribing for Renal Function in Long-Term Care Residents with Chronic Kidney Disease
Section snippets
Background
Polypharmacy is commonly encountered in Long-term Care (LTC) residents and associated with adverse drug events (ADEs) and worsening function. Data from a prior PI project1 resulted in an average deprescribing (DeP) of 1.3 medications per resident encounter. The presence of Chronic Kidney Disease (CKD) calls for attempts at DeP not only to minimize polypharmacy but also to adjust drug dosage for renal function and prevent harm. While CKD is common in older adults, data on DeP in CKD is scarce.
Objective/Aim
As part of a requirement in geriatric medicine fellowship programs, in August 2021 we began a PI project to explore DeP in LTC residents, aged 60 years or over, with CKD stage 2 or worse, in 3 nursing homes in the Bronx.
Quality Improvement Methods
Fellows attempted DeP during the monthly resident encounters under supervision of Geriatric Medicine faculty attendings. A tool was utilized to gather data, then entered into an excel file. A DeP algorithm1 (JAMDA 2020) aided the efforts. MDRD ( Modification of Diet in Renal Disease) equation was used to calculate the eGFR (estimated glomerular filtration rate). The target is to address over 100 residents by January 2022.
Results
A total of 71 LTC residents >60 years were enrolled. 69% were females, mean age 82.3 years. Mean number of co-morbidities was 5.88 +/- 2.6. Other data is depicted in the table. Residents and caregivers offered full cooperation.DATA ON 71 LTC RESIDENTS OVER 60 YEARS OF AGE Mean age (years) 82.3 Gender Female 69 % Number of Co-morbidities (Mean+/- SD) 5.88+/-2.6 Most common co- morbidities CKD stage 2 or more 100% Hypertension 80.2% Anemia 76% Hyperlipidemia 61.9% Constipation 52.1% Mean Number of Medications
Conclusions
*DeP in LTC residents with CKD stage 2 or worse can be implemented, as demonstrated in this PI project.
*Such DeP is possible during routinely planned physician-resident encounters.
*Programmed DeP efforts over time offers a means to effectively address polypharmacy and potentially reduce adverse outcomes.
- 1.
Dharmarajan TS et al. Deprescribing as a clinical improvement focus. JAMDA. 2020;21:355-360
Disclosures
All authors have stated there are no financial disclosures to be made that are pertinent to this abstract.