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1 Divisione di Medicina Geriatrica, Istituto Nazionale di Ricovero e Cura per Anziani (INRCA), Cosenza, Italy.
2 Centro di Medicina dell'Invecchiamento, Policlinico A. Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy.
3 Dipartimento di Medicina Interna, Università degli Studi di Messina, Italy.
4 Dipartimento di Medicina e Scienze dell'Invecchiamento, Università degli Studi "G. D'Annunzio," Chieti, Italy.
Address correspondence to Andrea Corsonello, MD, Via D. Frugiuele, 39, I-87100 Cosenza, Italy. E-mail: andrea_corsonello{at}tin.it
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.
This article has been cited by other articles: (Search Google Scholar for Other Citing Articles)
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  F. L. Fimognari, A. Corsonello, R. Pastorell, and R. Antonelli-Incalzi Metformin-Induced Pancreatitis: A possible adverse drug effect during acute renal failure Diabetes Care, May 1, 2006; 29(5): 1183 - 1183. [Full Text] [PDF]
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 C. Pedone, A. Corsonello, R. A. Incalzi, and for The GIFA Investigators Estimating renal function in older people: a comparison of three formulas Age Ageing, March 1, 2006; 35(2): 121 - 126. [Abstract] [Full Text] [PDF]
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 G. S. Meneilly Diabetes Is Common in Elderly Persons J. Gerontol. A Biol. Sci. Med. Sci., September 1, 2005; 60(9): 1145 - 1146. [Full Text] [PDF]
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| Journals of Gerontology Series B: Psychological Sciences and Social Sciences | |
