Evidence map›Paper›PMID 26503124›Full record

ArticleJournal of the American Geriatrics Society2015

Use of Renally Inappropriate Medications in Older Veterans: A National Study.

Flora Chang, Ann M O'Hare, Yinghui Miao, Michael A Steinman

Erratum issuedOpen access · greenAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Journal of the American Geriatrics Society, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 36 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
36citing papers in PubMed, 1 pooled it
3.2field-weighted citation impact, top 8% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

36 citing papers in PubMed, 1 synthesis or guideline pooled it, 75 citations in OpenAlex.

  1. Pooled it
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  5. Population Health Management for Improving Kidney Health Outcomes.American journal of kidney diseases : the official journal of the National Kidney Foundation · 2025
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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

4 authors at 2 institutions in 1 country.

Flora ChangSchool of Medicine, University of California at Davis, Davis, California.
Ann M O'HareDivision of Nephrology, University of Washington, Seattle, Washington.
Yinghui MiaoDivision of Geriatrics, University of California San Francisco, San Francisco, California.
Michael A SteinmanDivision of Geriatrics, University of California San Francisco, San Francisco, California.
San Francisco VA Medical Center · USVeterans Health Administration · US

Funding

VARC CoreP30AG044281 · NIA · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI Louise C. Walter · 2013 to 2026
$19.9M
Prescribing cascades in older adults with and without dementiaK24AG049057 · NIA · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI STEINMAN, MICHAEL A. · 2015 to 2025
$1.8M
Improving Medication Therapy for Older Patients with Common Co-morbiditiesRC1AG036377 · NIA · JEWISH HOME OF SAN FRANCISCO · PI SCHWARTZ, JANICE B · 2009 to 2010
$832k
Guideline Adherence in Elders With Multiple ComorbiditiesK23AG030999 · NIA · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI STEINMAN, MICHAEL A. · 2008 to 2010
$391k
NIA NIH HHS K23 AG030999NIA NIH HHS K24 AG049057NIA NIH HHS P30 AG044281NIA NIH HHS RC1 AG036377
6 · The paper itself

Abstract

objectivesTo determine how many ambulatory older adults with chronic kidney disease receive medications that are contraindicated or dosed excessively given their level of renal function.

designCross-sectional retrospective study.

settingU.S. Department of Veterans Affairs (VA) clinics.

participantsIndividuals aged 65 and older with a creatinine clearance (CrCl) of 15 to 49 mL/min (N = 83,850; mean age 80; 96% male). MEASUREMENTS: Forty medications that require dose adjustment or are contraindicated in people with impaired renal function were examined. Medication use and CrCl (calculated using the Cockroft-Gault equation) were assessed using VA pharmacy, laboratory, and other data sources as of October 2007.

resultsThirteen percent of older veterans with a CrCl of 30 to 49 mL/min and 32% of those with a CrCl of 15 to 29 mL/min received one or more drugs that were contraindicated or prescribed at an excessive dose given the individual's level of renal function. The strongest risk factor for renally inappropriate prescribing was number of medications used; the risk of receiving renally inappropriate medications was 5.5 times as high (95% confidence interval = 5.1-5.9) in older adults taking 10 or more medications as in those taking one to three medications. Ranitidine, allopurinol, and metformin together accounted for 76% of renally misprescribed medications in individuals with a CrCl of 30 to 49 mL/min. Glyburide, ranitidine, gemfibrozil, carvedilol, and allopurinol accounted for 47% of renally misprescribed drugs for individuals with a CrCl of 15 to 29 mL/min.

conclusionInappropriate prescribing of renally cleared medications is common in ambulatory older veterans, with only a few medications accounting for most of these prescribing problems.

Indexed as

AgedAged, 80 and overAllopurinolAminohydrolasesBody WeightComorbidityCross-Sectional StudiesFemaleHumansInappropriate PrescribingMaleMetforminRanitidineRenal Insufficiency, ChronicRetrospective StudiesUnited StatesAllopurinolAminohydrolasescreatinine deiminaseMetforminRanitidinechronic kidney diseasedrug usepharmacoepidemiologyquality of careveterans

Identifiers

PMID26503124
PMCPMC4733653
OpenAlexW1927516344

What OpenQuestion holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.