Comprehensive geriatric assessment and drug burden in elderly chronic kidney disease patients

• Published in: Türk biyokimya dergisi Vol. 48; no. 5; pp. 586 - 591
• Main Authors: Erken, Neziha, Erken, Ertugrul
• Format: Journal Article
• Language: English
• Published: De Gruyter 20-10-2023
• Subjects: anticholinergic burden; chronic kidney disease; drug interaction; frailty; geriatric syndromes; polypharmacy
• ISSN: 1303-829X; 1303-829X
• DOI: 10.1515/tjb-2023-0189

Abstract
Objectives
Chronic kidney disease (CKD) is a condition characterized by atherosclerosis, cognitive impairment, physical limitations, biochemical abnormalities, and vascular aging. The proportion of those with a diagnosis of CKD in the older is increasing. With comprehensive geriatric assessment, it could be possible to detect the disorders that are related to biological aging. The aim is to evaluate geriatric syndromes like frailty, cognitive dysfunction, malnutrition, and polypharmacy in an aged population with pre-dialytic CKD (stages 3a–5), and to investigate possible relations with biochemical features and anticholinergic drug burden (ADB).
Methods
One hundred and fifty-six CKD patients aged 60 and older and 164 healthy controls were included in the study. Geriatric parameters that were used for the evaluation of the groups were, Clinical Frailty Index; Charlson Comorbidity Index; Montreal Cognitive Assessment and Mini Nutritional Assessment Short-Form. Besides, biochemical parameters and ADB defined with 3 scales Anticholinergic Burden Classification (ABC), Chew’s scale, and Drug Burden Index were recorded.
Results
Despite being younger, CKD patients had higher comorbidity and frailty scores than the controls. Patients and controls had similar nutritional status, and cognitive function test results. Frailty was an important predictor for geriatric parameters and eGFR. ABC score was higher in the CKD group in ADB scale.
Conclusions
Frailty and polypharmacy are more prevalent than expected in older with CKD. In addition, anticholinergic burden and polypharmacy may form causal links with one and other and lead to increased mortality rates especially with frailty. Therefore, geriatric assessment and appropriate ADB evaluation may be recommended in CKD patients.