Abstract
Introduction: With the rising elderly population with comorbid conditions, the prevalence of polymedication has significantly increased. As the kidney is the main organ of drug elimination, renal insufficiency leads to a risk of adverse drug reactions (ADRs).Material and methods: In a cohort of nursing homes (EHPAD) elderly patients referred in 2019 to the Montpellier University Hospital emergency department (ED), we selected the patients with a glomerular filtration rate below 30 ml/min/1.73m 2 at admission. We searched for contraindicated drugs and ADR in their medical files.Results: During the study period, 1061 ED admissions were recorded. Among these, 111 (10.5%) involved patients with severe renal failure (GRF < 30 ml/min/1.73m 2) (59 women and 52 men). In this group, 66 admissions (59.5%) led to hospitalization including 15 (22.7%) related to ADRs. Drugs contraindicated in severe renal failure directly and related to ADRs were used in 8 of these 15 cases (53.3%). There were 5 bleeding disorders associated with anticoagulants or anti-aggregants and 3 lactic acidosis associated with metformin.Discussion/Conclusion: In the elderly population with severe renal failure, almost one in four hospitalizations resulted from one or more ADRs and nearly half of these were associated with a drug normally contraindicated in severe renal failure. This result illustrates the extreme vulnerability of this population to drug iatrogeny. It is also consistent with previous studies highlighting the avoidable proportion of ADRs [1], particularly in the elderly, and the still frequent occurrence of well-known ADRs (such as lactic acidosis with metformin). Prescribing drugs to elderly patients with renal insufficiency is risky and clinical monitoring must be very close to improve drug safety and prevent iatrogeny.Reference: [1] Laroche ML et al. Incidence and preventability of hospital admissions for adverse drug reactions in France: A prospective observational study (IATROSTAT). British journal of clinical pharmacology vol. 89,1 (2023): 390–400.