Mogućnost depreskripcije kod hospitaliziranih pacijenata starije životne dobi s kroničnom bubrežnom bolesti

master's thesis

• Title (english): Potential for deprescription in hospitalized elderly patients with chronic kidney disease
• Author: Marin Špiko
• Mentor: Ivana Marinović (mentor)
• Mentor: Ivana Samardžić (sumentor)
• Committee member: Ivana Marinović (predsjednik povjerenstva)
• Committee member: Ivana Samardžić (član povjerenstva)
• Committee member: Maja Ortner Hadžiabdić (član povjerenstva)
• Granter: University of Zagreb; Faculty of Pharmacy and Biochemistry; (Centre for applied pharmacy); Zagreb
• Defense date and country: 2024-06-17, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Pharmacy; Pharmacy

Abstract

Kronična bubrežna bolest je multifaktorijalna bolest čija je globalna prevalencija u stalnom porastu. Utvrđeno je da od ove bolesti uglavnom
obolijevaju stariji pacijenti. Starenjem dolazi do niza promjena strukturalne i funkcionalne prirode, što dovodi do izmijenjene farmakokinetike i
farmakodinamike lijekova kod osoba starije životne dobi. Ovakvi pacijenti najčešće pate od većeg broja komorbiditeta te im se posljedično propisuje
veliki broj lijekova i javlja problem politerapije i polipragmazije. Brojni propisani lijekovi mogu biti potencijalno neprikladni ili rizični za primje nu
s obzirom na smanjenu bubrežnu funkciju kod bolesnika s KBB. Cilj ovoga istraživanja bio je analizirati farmakoterapiju ispit anih sudionika svih
starijih od 65 godina oboljelih od KBB primjenom najbolje moguće medikacijske povijesti (NMMP) te utvrditi PNL -ove koristeći EU(7)-PIM
smjernice i rizične lijekove s obzirom na stupanj oštećenja bubrežne funkcije. Utvrđivanjem PNL -ova i rizičnih lijekova moći će se ponuditi
mogućnosti depreskripcije kod ovakvih bolesnika. U istraživanju je sudjelovalo 26 pacijenata zaprimljenih i hospitaliziranih u KB Dubrava u Zagrebu.
Podaci za sve pacijente prikupljali su se pomoću obrasca NMMP. Analizom prikupljenih podataka iz obrasca, utvrđena je politerapija za svakog
sudionika. PNL-ovi su utvrđivani primjenom smjernica EU(7)-PIM liste, dok su rizični lijekovi utvrđivani prema preporukama HALMED-a. Prema
rezultatima istraživanja, politerapija je utvrđena u 92,3 % ispitanika, gdje je 58,3 % pacijenata uzimalo 5-9 lijekova u svojoj terapiji, a 38,5 % 10 ili
više lijekova. Najzastupljeniji su bili lijekovi iz ATK skupine C koji djeluju na srce i krvožilje. Otkriveno je ukupno 54 PN L-ova, a čak 84,6 %
pacijenata je imalo barem 1 PNL u svojoj terapiji. Najzastupljeniji PNL-ovi su bili pantoprazol, moksonidin i tramadol. Nadalje, analizom podataka
otkriveno je 20 lijekova za koje je potrebna prilagodba doze, dok je ukupno u terapijama ispitanika prisutno 23 lijeka čija je primjena kontraindicirana
s obzirom na stupanj bubrežnog oštećenja. Dobiveni rezultati jasno upućuju na to da je depreskripcija od osobite važnosti za pacijente s KBB. Bitno
je procjenjivati mogućnost depreskripcije na prijemu, tijekom hospitalizacije i na otpustu, a u tom procesu važnu ulogu treba imati i klinički farmaceut
u koordinaciji s drugim zdravstvenim profesionalcima i samim pacijentom.

Abstract (english)

Chronic kidney disease is a multifactorial illness with a steadily increasing global prevalence. It has been established that this disease primarily affects
older patients. Aging brings a series of structural and functional changes, leading to altered pharmacokinetics and pharmacod ynamics of drugs in the
elderly. Such patients often suffer from multiple comorbidities, resulting in the prescription of numerous medications and the issue of polypharmacy
and polypragmasy. Many prescribed drugs can be potentially inappropriate or risky considering the reduced renal function in patients with chronic
kidney disease (CKD). The aim of this research was to analyze the pharmacotherapy of the study participants, all older than 6 5 years and suffering
from CKD, using the best possible medication history (BPMH) and to identify potentially inappropriate medications (PIMs) using the EU(7)-PIM
guidelines and risky medications in relation to the degree of renal impairment. Identifying PIMs and risky drugs will allow for deprescription
opportunities in such patients. The study involved 26 patients admitted and hospitalized at KB Dubrava in Zagreb. Data for all patients was collected
using the BPMH form within 24 hours of patient's admission to KB Dubrava. Analyzing the collected data from the form, polypha rmacy was identified
for each participant. PIMs were identified using the EU(7)-PIM list guidelines, while risky drugs were identified according to HALMED
recommendations. According to the study results, polypharmacy was found in 92.3 % of the participants, with 58.3 % of patient s taking 5-9 drugs in
their therapy, and 38.5 % taking 10 or more drugs. The most common drugs were from the ATC group C, which act on the heart and blood vess els. A
total of 54 PIMs were identified, and 84.6 % of patients had at least one PIM in their therapy. The most common PIMs were pa ntoprazole, moxonidine,
and tramadol. Furthermore, data analysis revealed 20 drugs that required dose adjustment, while a total of 23 drugs present i n the therapies of the
participants were contraindicated considering the degree of renal impairment. The obtained results clearly indicate that deprescription is of particular
importance for patients with CKD. It is crucial to evaluate the possibility of deprescription at admission, during hospitalization, and at discharge. In
this process, the clinical pharmacist should play an important role in coordination with other healthcare professionals and the patient themselves.

• Keywords: depreskripcija; kronična bubrežna bolest; stariji pacijenti; politerapija; potencijalno neprikladni lijekovi; EU(7)-PIM smjernice
• Keywords (english): deprescription; chronic kidney disease; elderly patients; polytherapy; potentially inappropriate medications; EU(7)-PIM list
• Language: croatian
• URN:NBN: urn:nbn:hr:163:416549
• Study programme: Title: Pharmacy - integrated undergraduate and graduate - university study; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: sveučilišni magistar farmacije (sveučilišni magistar farmacije)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2024-09-25 11:09:39