Medication in nursing homes: don't forget the kidney

One in five nursing home residents receives medication whose dose has not been adjusted to their kidney function or which would even be inadvisable due to - often age-related - kidney weakness. This is the conclusion reached by a team of researchers led by Oldenburg healthcare researcher Prof Dr Falk Hoffmann in a study of 852 residents from 21 nursing homes in Bremen and Lower Saxony, the results of which were recently published in the German Medical Journal. In the body, the kidneys not only have the task of excreting excess water, but also medicines or their degradation products. Many nursing home residents receive several long-term medications, which are either not recommended at all in the case of kidney weakness or whose dosage should at least be adjusted to the kidney function - actually. The interdisciplinary team of researchers found that not all nursing home residents were aware of their kidney function, let alone that the relevant value of the metabolic product creatinine was regularly determined. "It would be desirable for the creatinine value to be recorded at least once a year, which should then be available to all those involved in care," emphasises Hoffmann. The researchers had information on kidney function for 685 of the 852 nursing home residents included in the study. Of these 685, almost half (a good 48 per cent) suffered from moderate renal insufficiency and a further 15 per cent from severe renal insufficiency. 135 residents - almost 20 per cent - were receiving at least one drug that was not dosed according to the relevant prescribing information or was contraindicated. A contraindication is a contraindication, i.e. a circumstance that basically prohibits the administration of a certain medication. Specialist information corresponds to an extended "package leaflet" with manufacturer's instructions for doctors and pharmacists. In terms of patients with known renal insufficiency, the 135 patients with overdosed or contraindicated medication represent a good 30 per cent. "The dose of many drugs depends on kidney function," explains pharmacist Dr Michael Dörks, one of the co-authors of the article and a member of the School V - School of Medicine and Health Sciences at the University of Oldenburg. "The kidney helps to excrete medication. If it no longer functions properly, the drug may remain in the body for longer." In this case, the usual amount of active ingredient means an overdose. This can result in serious side effects, which can also lead to hospitalisation. Hoffmann was not surprised that one in five care home residents was exposed to this risk. "As many as 90 per cent of the residents in our study received medication that is dose-adjusted or even contraindicated for renal insufficiency," emphasises Hoffmann. In addition to an annual assessment of the renal function of nursing home residents, the authors call for a standardised and practicable guide for doctors that lists dose adjustments for renal insufficiency. The lack of such systematic preparation for everyday medical practice is "a considerable problem for the safety of drug therapy". The manufacturers and the regulating authorities are called upon here. Around 800,000 people live in nursing homes in Germany, many of whom are chronically ill and physically or cognitively impaired. The article "Renal insufficiency and medication in nursing home residents" published in the German Medical Journal is just one of several recent publications in which the Oldenburg care researchers, together with colleagues from Bremen, shed light on the care situation in nursing homes.