[Occult renal disease and drug prescription in primary care].

OBJECTIVE

To study the prevalence of chronic kidney disease (CKD) [glomerular filtration rate (GFR) <60ml/min/1.73m(2)] and occult kidney disease (OKD) (normal serum creatinine values with GFR <60) in elderly patients.

DESIGN

Retrospective, observational study.

SETTING

Four primary care centres in the province of Huesca, Spain.

PARTICIPANTS

About 4014 patients older than 65 years were randomly selected.

MAIN MEASUREMENTS: GFR was calculated for all subjects using the four-variable modified MDRD equation. We registered all drugs prescriptions to the patients during a period of twelve months focusing on the potential nephrotoxic drugs.

RESULTS

After exclusions, GFR was estimated in 3286 patients (1424 men of 75.49+/-6.6 years and 1862 women of 76.29+/-7.04 years; P=.001). The prevalence of CKD was 21.2%. A total of 10.1% of patients (12.8% of women and 6.44% of men) had OKD. We recorded the complete drug prescription in 269 patients. Mean of all different drugs that were prescribed by patient-year was 10.69+/-5.92 (men 9.55+/-5.57 and women 11.11+/-6; P=.05)]. A large number of patients were treated with potentially dangerous drugs, particularly the non-steroidal anti-inflammatory drugs with 165 cases (61.34%), and 72% were exposed to drugs that can lead to hyperkalaemia.

CONCLUSIONS

We conclude that GFR estimation by clinical laboratories in the setting of primary care can contribute to prevent the adverse effects of inappropriate drug prescriptions.