Concealed renal failure and adverse drug reactions in older patients with type 2 diabetes mellitus

Andrea Corsonello, Claudio Pedone, Francesco Corica, Bruno Mazzei, Angelo Di Iorio, Pierugo Carbonin, Raffaele Antonelli Incalzi

Research output: Contribution to journalArticle

48 Citations (Scopus)

Abstract

Background. In elderly patients serum creatinine may be normal despite decreased glomerular filtration rate (GFR). The aim of this study was to evaluate the prevalence of this "concealed" renal failure, i.e., renal failure with normal serum creatinine levels, in elderly diabetic patients, and to verify whether it is a risk factor for adverse drug reactions (ADR) to hydrosoluble drugs. Methods. We used data on 2257 hospitalized patients with type 2 diabetes mellitus enrolled in the Gruppo Italiano di Farmacovigilanza nell'Anziano study. On the basis of serum creatinine and calculated GFR, patients were grouped as follows: normal renal function (normal serum creatinine levels and normal GFR), concealed (normal serum creatinine levels and reduced GFR), or overt (increased creatinine levels and reduced GFR) renal failure. GFR was calculated using the Modification of Diet in Renal Disease (MDRD) equation. The outcome of the study was the incidence of ADR to hydrosoluble drugs during the hospital stay. The relationship between renal function and ADR was evaluated using Cox regression analysis including potential confounders. Results. Concealed renal failure was observed in 363 (16.1%) of patients studied. Patients with concealed or overt renal failure were older, had more frequently cognitive impairment and polypharmacy, and had lower serum albumin levels than did those with normal renal function. Both concealed (hazard ratio = 1.90; 95% confidence interval, 1.04-3.48; p = .036) and overt (hazard ratio = 2.23; 95% confidence interval, 1.40-3.55; p = .001) renal failure were significantly associated with ADR to hydrosoluble drugs. The use of more than four drugs also qualified as an independent risk factor for ADRs to hydrosoluble drugs during hospital stay. Conclusions. Older diabetic patients should be systematically screened to ascertain the presence of concealed renal failure in an attempt to optimize the pharmacological treatment and reduce the risk of ADRs.

Original languageEnglish
Pages (from-to)1147-1151
Number of pages5
JournalJournals of Gerontology - Series A Biological Sciences and Medical Sciences
Volume60
Issue number9
Publication statusPublished - Sep 2005

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Drug-Related Side Effects and Adverse Reactions
Type 2 Diabetes Mellitus
Renal Insufficiency
Glomerular Filtration Rate
Creatinine
Kidney
Serum
Pharmaceutical Preparations
Length of Stay
Confidence Intervals
Diet Therapy
Polypharmacy
Serum Albumin
Regression Analysis
Outcome Assessment (Health Care)
Pharmacology
Incidence

ASJC Scopus subject areas

  • Ageing

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Concealed renal failure and adverse drug reactions in older patients with type 2 diabetes mellitus. / Corsonello, Andrea; Pedone, Claudio; Corica, Francesco; Mazzei, Bruno; Di Iorio, Angelo; Carbonin, Pierugo; Incalzi, Raffaele Antonelli.

In: Journals of Gerontology - Series A Biological Sciences and Medical Sciences, Vol. 60, No. 9, 09.2005, p. 1147-1151.

Research output: Contribution to journalArticle

Corsonello, Andrea ; Pedone, Claudio ; Corica, Francesco ; Mazzei, Bruno ; Di Iorio, Angelo ; Carbonin, Pierugo ; Incalzi, Raffaele Antonelli. / Concealed renal failure and adverse drug reactions in older patients with type 2 diabetes mellitus. In: Journals of Gerontology - Series A Biological Sciences and Medical Sciences. 2005 ; Vol. 60, No. 9. pp. 1147-1151.
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abstract = "Background. In elderly patients serum creatinine may be normal despite decreased glomerular filtration rate (GFR). The aim of this study was to evaluate the prevalence of this {"}concealed{"} renal failure, i.e., renal failure with normal serum creatinine levels, in elderly diabetic patients, and to verify whether it is a risk factor for adverse drug reactions (ADR) to hydrosoluble drugs. Methods. We used data on 2257 hospitalized patients with type 2 diabetes mellitus enrolled in the Gruppo Italiano di Farmacovigilanza nell'Anziano study. On the basis of serum creatinine and calculated GFR, patients were grouped as follows: normal renal function (normal serum creatinine levels and normal GFR), concealed (normal serum creatinine levels and reduced GFR), or overt (increased creatinine levels and reduced GFR) renal failure. GFR was calculated using the Modification of Diet in Renal Disease (MDRD) equation. The outcome of the study was the incidence of ADR to hydrosoluble drugs during the hospital stay. The relationship between renal function and ADR was evaluated using Cox regression analysis including potential confounders. Results. Concealed renal failure was observed in 363 (16.1{\%}) of patients studied. Patients with concealed or overt renal failure were older, had more frequently cognitive impairment and polypharmacy, and had lower serum albumin levels than did those with normal renal function. Both concealed (hazard ratio = 1.90; 95{\%} confidence interval, 1.04-3.48; p = .036) and overt (hazard ratio = 2.23; 95{\%} confidence interval, 1.40-3.55; p = .001) renal failure were significantly associated with ADR to hydrosoluble drugs. The use of more than four drugs also qualified as an independent risk factor for ADRs to hydrosoluble drugs during hospital stay. Conclusions. Older diabetic patients should be systematically screened to ascertain the presence of concealed renal failure in an attempt to optimize the pharmacological treatment and reduce the risk of ADRs.",
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T1 - Concealed renal failure and adverse drug reactions in older patients with type 2 diabetes mellitus

AU - Corsonello, Andrea

AU - Pedone, Claudio

AU - Corica, Francesco

AU - Mazzei, Bruno

AU - Di Iorio, Angelo

AU - Carbonin, Pierugo

AU - Incalzi, Raffaele Antonelli

PY - 2005/9

Y1 - 2005/9

N2 - Background. In elderly patients serum creatinine may be normal despite decreased glomerular filtration rate (GFR). The aim of this study was to evaluate the prevalence of this "concealed" renal failure, i.e., renal failure with normal serum creatinine levels, in elderly diabetic patients, and to verify whether it is a risk factor for adverse drug reactions (ADR) to hydrosoluble drugs. Methods. We used data on 2257 hospitalized patients with type 2 diabetes mellitus enrolled in the Gruppo Italiano di Farmacovigilanza nell'Anziano study. On the basis of serum creatinine and calculated GFR, patients were grouped as follows: normal renal function (normal serum creatinine levels and normal GFR), concealed (normal serum creatinine levels and reduced GFR), or overt (increased creatinine levels and reduced GFR) renal failure. GFR was calculated using the Modification of Diet in Renal Disease (MDRD) equation. The outcome of the study was the incidence of ADR to hydrosoluble drugs during the hospital stay. The relationship between renal function and ADR was evaluated using Cox regression analysis including potential confounders. Results. Concealed renal failure was observed in 363 (16.1%) of patients studied. Patients with concealed or overt renal failure were older, had more frequently cognitive impairment and polypharmacy, and had lower serum albumin levels than did those with normal renal function. Both concealed (hazard ratio = 1.90; 95% confidence interval, 1.04-3.48; p = .036) and overt (hazard ratio = 2.23; 95% confidence interval, 1.40-3.55; p = .001) renal failure were significantly associated with ADR to hydrosoluble drugs. The use of more than four drugs also qualified as an independent risk factor for ADRs to hydrosoluble drugs during hospital stay. Conclusions. Older diabetic patients should be systematically screened to ascertain the presence of concealed renal failure in an attempt to optimize the pharmacological treatment and reduce the risk of ADRs.

AB - Background. In elderly patients serum creatinine may be normal despite decreased glomerular filtration rate (GFR). The aim of this study was to evaluate the prevalence of this "concealed" renal failure, i.e., renal failure with normal serum creatinine levels, in elderly diabetic patients, and to verify whether it is a risk factor for adverse drug reactions (ADR) to hydrosoluble drugs. Methods. We used data on 2257 hospitalized patients with type 2 diabetes mellitus enrolled in the Gruppo Italiano di Farmacovigilanza nell'Anziano study. On the basis of serum creatinine and calculated GFR, patients were grouped as follows: normal renal function (normal serum creatinine levels and normal GFR), concealed (normal serum creatinine levels and reduced GFR), or overt (increased creatinine levels and reduced GFR) renal failure. GFR was calculated using the Modification of Diet in Renal Disease (MDRD) equation. The outcome of the study was the incidence of ADR to hydrosoluble drugs during the hospital stay. The relationship between renal function and ADR was evaluated using Cox regression analysis including potential confounders. Results. Concealed renal failure was observed in 363 (16.1%) of patients studied. Patients with concealed or overt renal failure were older, had more frequently cognitive impairment and polypharmacy, and had lower serum albumin levels than did those with normal renal function. Both concealed (hazard ratio = 1.90; 95% confidence interval, 1.04-3.48; p = .036) and overt (hazard ratio = 2.23; 95% confidence interval, 1.40-3.55; p = .001) renal failure were significantly associated with ADR to hydrosoluble drugs. The use of more than four drugs also qualified as an independent risk factor for ADRs to hydrosoluble drugs during hospital stay. Conclusions. Older diabetic patients should be systematically screened to ascertain the presence of concealed renal failure in an attempt to optimize the pharmacological treatment and reduce the risk of ADRs.

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