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Medication-Induced Nephrotoxicity in Older Patients
Sergio Fusco, Sabrina Garasto, Andrea Corsonello1
1Unit of Geriatric Pharmacopidemiology, Italian National Research Centre on Aging, C. da Muoio Piccolo, 87100 Cosenza, Italy. andrea_corsonello@tin.it.
Medication-induced nephrotoxicity is a significant concern in older adults, particularly those over 75, due to complex medication regimens. Effective prevention requires considering patient factors, medications, and their interactions.
Area of Science:
- Gerontology
- Nephrology
- Pharmacology
Background:
- Older adults (≥75 years) are highly susceptible to medication-induced nephrotoxicity.
- Complex polypharmacy regimens increase the risk of adverse drug reactions affecting kidney function.
- Age-related changes in kidney structure and function predispose older individuals to nephrotoxicity.
Purpose of the Study:
- To review current evidence on the mechanisms, clinical features, diagnosis, and prevention of medication-induced nephrotoxicity in older populations.
- To identify knowledge gaps and areas for future research in this critical area.
Main Methods:
- Comprehensive literature search of PubMed.
- Inclusion of studies on age-related kidney changes, nephrotoxicity mechanisms, drug metabolism, epidemiology, biomarkers, and prevention strategies.
- Systematic review of 245 selected papers.
Main Results:
- Medications can cause nephrotoxicity via multiple mechanisms, with older adults being particularly vulnerable.
- Creatinine-based estimated glomerular filtration rate (eGFR) has limitations in assessing kidney function in the elderly.
- Innovative biomarkers for acute kidney injury (AKI) lack standardization and systematic evaluation in older populations.
Conclusions:
- Medication-induced nephrotoxicity is a major health issue in the elderly.
- Further research is needed on the impact on functional outcomes, diagnostic reliability, biomarker utility, and prevention strategy effectiveness in older adults.
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