To establish consensus oral dosing guidelines for primarily renally cleared medications prescribed for older adults.
Two-round modified Delphi Survey.
Expert panel of 11 geriatric clinical pharmacists.
After a comprehensive literature search and review by the investigative group of 6 physicians (2 from general internal medicine, 2 nephrologists, 2 geriatricians), 45 dosing recommendations for 30 medications at various levels of renal function were created. The expert panel rated their agreement with each of these 45 dosing recommendations using a 5-point Likert scale (1= strongly disagree to 5=strongly agree). Recommendation-specific means and 95% confidence intervals were estimated. Consensus was defined as a lower 95% confidence limit of >4.0 for the recommendation –specific mean score.
The response rate was 81.8% (9/11) for the first round. All respondents that completed the first round also completed the second round. The expert panel reached consensus on 26 recommendations involving 18 (60%) medications. For 10 medications (chlorpropamide, colchicine, cotrimoxazole, glyburide, meperidine, nitrofurantoin, probenecid, propoxyphene, spironolactone, and triamterene), the consensus recommendation was not to use the medication in older adults below a specified level of renal function (e.g., creatinine clearance < 30 ml/min). For the remaining 8 medications (acyclovir, amantadine, ciprofloxacin, gabapentin, memantine, ranitidine, rimantadine, and valacyclovir), specific recommendations for dose reduction or interval extension were made.
An expert panel of geriatric clinical pharmacists was able to reach consensus agreement on a number of oral medications that are primarily renally cleared.
Keywords: aged, chronic kidney disease, suboptimal prescribing