[Prevention of adverse events through renal dosage adjustment in institutionalized elders]

To present a protocol based on renal dosage adjustment developed to reduce the risk of adverse events in elderly people institutionalized in a geriatric centre and to determine the degree of adaptation to this protocol.

First, we designed a renal adjustment protocol to identify residents with creatinine clearance below 60ml/min, review drug therapy and optimize dosage regimens, if necessary. Then, we evaluated the feasibility of this protocol and adaptation of clinical practice to this protocol through a cross-sectional study of all the residents in the centre.

Among the 163 residents assessed by Cockroft-Gault, there were 126 residents with creatinine clearance below 60ml/min (77%; 95% CI, 70-83). Seventeen residents were excluded due to intake of protein supplements or to extreme body mass index. Once the treatments were reviewed, 152/876 (17%; 95% CI, 15-20) prescriptions suitable for renal adjustment were found. In 135/152 prescriptions (89%; 95% CI, 83-93) the dosage was appropriate to creatinine clearance and 17 (11%; 95% CI, 6-17) were considered as potentially optimizable. For these 17 prescriptions, a proposal for dosage adjustment or monitoring was made, which was accepted in 16 cases and rejected in 1 case (metformin in a patient with 44ml/min creatinine clearance and poor glycemic control).

A high percentage of the institutionalized elderly have a creatinine clearance below 60ml/min. Given that a not inconsiderable proportion of their prescribed medication is susceptible to renal adjustment, the implementation of a protocol for renal adjustment and renal function follow-up could help to reduce the risk of adverse events.