[Medication use in older patients with chronic renal failure]

Adverse drug reactions in the elderly are of growing concern because of the increasing elderly population and the increasing numbers of medications prescribed to this group. Ageing and the frequent comorbid diseases in the elderly result in altered drug pharmacokinetics and pharmacodynamics increasing the risk of side effects. The decline in renal function affects the elimination of many drugs. Before prescribing an estimation of the glomerular filtration rate is of the highest importance. All the nomogramms and formulae are approximate in the oldest old. The Cockcroft and Gault formula is frequently used. Pharmacodynamic alterations are particularly important for the centrally active drugs that older people are more vulnerable to, for example increased and prolonged effects of anticholinergic, hypnotic and sedative drugs. Polypharmacy and self-medication is also common in these patients, with increased chance for drug-drug interactions. In France, the recent law on Public Health (August 09, 2004) requires for the next five years to decrease the frequency of inappropiate prescriptions in elderly people and of to decrease the frequency of the drug-induced hospitalisations. Undertreatment of the elderly is not the solution: it's necessary to optimize their medication: to well appreciate before prescription their motor and cognitive deficiencies interfering with compliance, to "start low and go slow" their medications, to review their drug consumption on a regular basis, to educate them and their family for a good observance.