Renally inappropriate medication (RIM)refers to the administration of drugs without proper dosage adjustment based on renal function or the use of contraindicated agents, primarily including nephrotoxic agents and renally excreted medications.Such practices may accelerate disease progression and increase the risk of adverse drug events, posing a significant burden on China's healthcare system.Early identification and intervention for RIM in elderly patients provide critical opportunities to mitigate the decline in abnormal renal function.Currently, there is a lack of specific, actionable guidelines for preventing RIM in elderly patients with chronic kidney disease(CKD)in China.This expert consensus systematically reviews evidence-based medical literature from domestic and international studies over the past two decades, integrates expertise and clinical insights from geriatric medicine and clinical pharmacology specialists to establish practical recommendations for preventing RIM in elderly patients with CKD.

Renally inappropriate medication (RIM)refers to the administration of drugs without proper dosage adjustment based on renal function or the use of contraindicated agents, primarily including nephrotoxic agents and renally excreted medications.Such practices may accelerate disease progression and increase the risk of adverse drug events, posing a significant burden on China's healthcare system.Early identification and intervention for RIM in elderly patients provide critical opportunities to mitigate the decline in abnormal renal function.Currently, there is a lack of specific, actionable guidelines for preventing RIM in elderly patients with chronic kidney disease(CKD)in China.This expert consensus systematically reviews evidence-based medical literature from domestic and international studies over the past two decades, integrates expertise and clinical insights from geriatric medicine and clinical pharmacology specialists to establish practical recommendations for preventing RIM in elderly patients with CKD.

Humans ; Aged ; Acute Kidney Injury ; Risk Factors ; Creatinine

Objective This study was performed to investigate clinical characteristics of albuminuria in octagenarian or nanogenarian and provide primary study for chronic kidney disease in eldly patients.Methods The data of 218 patients with albumin-to-creatinine ratio (ACR)between 30 ~300 mg/g from first morning urine in hospital from June 2012 to December 2014 were analyzed retrospectively.Consec-utive hospitalized old patients were divided into 80 +group(aged from 80 to 89 years old)and 90 +group(age≥90 years old),who were al-so divided into albuminuria positive group(ACR 30 ~300 mg/g)and albuminuria negative group(ACR <30 mg/g)according to the ACR. Cohort study was performed to investigate albuminuria related characteristics.Results Of the 218 hospitalized old men,53.21% developed albuminuria with average Log ACR (1.78 ±0.85)mg/g.Albuminuria was positive in 45.16% of 80 +group compared to that of69.84% in 90 +group(P <0.05).For albuminuria positive old men average Log ACR (2.03 ±0.62)mg/g,while it was Log ACR(1.03 ±0.44)mg/g in al-buminuria negative old men.Positive rate of albuminuria in 80 + group vs.90 + group accompanied with either diabetes,hypertension or eGFR <60 mL·(min·1.73 m2 )-1 were 50% vs.77.5%(P <0.05),50.38% vs.58.82%(P >0.05),66.21% vs.75%(P >0.05), respectively.Of a few old men who were free from diabetes,hypertension or eGFR <60 mL·(min·1.73 m2 )-1 the corresponding rate of al-buminuria were 35.39% (21 /59),16.00%(4 /25)and 25.84% (23 /89),respectively.Conclusion Occurrence of albuminuria was seen in 53.21% of advanced aged hospitalized men,with tendency of higher occurrence rate in nanogenarian than those in the octogenarian.

Objective To compare the effects of different antiplatelet therapy on outcomes in patients with acute coronary syndrome (ACS). Methods 338 hospitalized patients with ACS were enrolled. They were assigned to three groups: group 1, aspirin alone after discharge, n=93; group 2, dual antiplatelet treatment of aspirin and clopidogrel after discharge for 6～12 months, then aspirin, n=127; and group 3, dual antiplatelet treatment of aspirin and clopidogrel after discharge for 2 years, n=118. All the patients were followed up for 2 years. The clinical data (basic clinical data, platelet count and serum lipids indeices), primary end point (cardiovascular death, nonfatal myocardial infarction and stroke) and hemorrhagic events (major hemorrhage, moderate hemorrhage and minor hemorrhage) within 1 and 2 years were analyzed. Results During 1 and 2 years, compared with group 1, the incidence of cardiovascular death and all primary end points of groups 2 and 3 decreased significantly (P＜0.05), but the nonfatal myocardial infarction and stroke did not （P＞0.05）. The difference was not statistically significant between groups 2 and 3 in all the end points （P＞0.05）. The difference of hemorrhagic events was not statistically significant among the 3 groups（P＞0.05）. Conclusion Dual antiplatelet treatment of clopidogrel plus aspirin for 2 years may decrease the mortality of cardiovascular disease while the incidence of severe hemorrhage doesn't increase.