scholarly journals An audit of lithium prescribing practices in an old age psychiatry service highlighting renal impairment in this cohort

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S109-S110
Author(s):  
Leia Valentine ◽  
John Cannon ◽  
Siobhan Marmion ◽  
Michelle Corcoran ◽  
Marguerite Cryan ◽  
...  
Keyword(s):  
Older Adults ◽  
Renal Function ◽  
Renal Impairment ◽  
Old Age ◽  
Thyroid Function ◽  
Serum Calcium ◽  
Prescribing Practices ◽  
Lithium Level ◽  
Increased Risk ◽  
One Year

AimsTo compare Lithium prescribing practices in a Psychiatry of Old Age (POA) Service in the North-West of Ireland among adults aged 65 years and over with best practice guidelines.MethodReview of the literature informed development of audit standards for Lithium prescribing. These included National Institute for Clinical Excellent (NICE) 2014 guidelines, The British National Formulary (2019) and Maudsley Prescribing Guidelines (2018). Data were collected retrospectively, using an audit-specific data collection tool, from clinical files of POA team caseload, aged 65 years or more and prescribed Lithium over the past one year.ResultAt the time of the audit in February 2020, 18 patients were prescribed lithium, 67% female, average age 74.6 years. Of those prescribed Lithium; 50% (n = 9) had a depression diagnosis, 44% (n = 8) had bipolar affective disorder (BPAD) and 6% (n = 1) had schizoaffective disorder.78% (n = 14) of patients were on track to meet, or had already met, the NICE standard of 3-monthly serum lithium level. Lithium levels were checked on average 4.5 times in past one year, average lithium level was 0.61mmol/L across the group and 39% (n = 7) had lithium level within recommended therapeutic range (0.6-0.8mmol/L).83% (n = 15) of patients met the NICE standards of 3 monthly renal tests, thyroid function test was performed in 89% (n = 16) and at least one serum calcium level was documented in 63% (n = 15). Taking into consideration most recent blood test results, 100% (n = 18) had abnormal renal function, 78% (n = 7) had abnormal thyroid function and 60% (n = 9) had abnormal serum calcium.Half (n = 9) were initiated on lithium by POA service and of these, 56% (n = 5) had documented renal impairment prior to initiation. Of patients on long term lithium therapy at time of referral (n = 9), almost half (n = 4) had a documented history of lithium toxicity.ConclusionThe results of this audit highlight room for improvement in lithium monitoring of older adults attending POA service. Furthermore, all patients prescribed lithium had impaired renal function, half had abnormal calcium and two fifths had abnormal thyroid function. This is an important finding given the associations between those admitted to hospital with COVID-19 and comorbid kidney disease and increased risk of inpatient death.Our findings highlight the need for three monthly renal function monitoring in older adults prescribed lithium given the additive adverse effects of increasing age and lithium on the kidney. Close working with specialised renal services to provide timely advice on renal management for those with renal impairment prescribed lithium is important to minimise adverse patient outcomes.

scholarly journals 402 - An audit of Lithium Prescribing Practices in an Old Age PsychiatryService highlighting renal impairment in this cohort

2021 ◽  
Vol 33 (S1) ◽  
pp. 29-30
Author(s):  
L. Valentine ◽  
J. Cannon ◽  
S. Marmion ◽  
M. Corcoran ◽  
M. Cryan ◽  
...  
Keyword(s):  
Renal Function ◽  
Renal Impairment ◽  
Old Age ◽  
Best Practice ◽  
Bipolar Affective Disorder ◽  
Prescribing Practices ◽  
Lithium Level ◽  
North West ◽  
The North ◽  
Increased Risk

AbstractAims:To compare Lithium prescribing practices in a Psychiatry of Old Age (POA) Service in the North-West ofIreland among adults aged 65 years and over with best practice guidelines.Methods:Review of the literature informed development of audit standards for Lithium prescribing. These included National Institute for Clinical Excellent (NICE) 2014 guidelines, The British National Formulary(2019) and Maudsley Prescribing Guidelines (2018). Data was collected retrospectively, using an audit-specific data collection tool, from clinical files of POA team caseload, aged 65 years or more and prescribed Lithium over the past year.Results:At the time of audit in February 2020, 18 patients were prescribed lithium, 67% female, average age 74.6 years. Of those prescribed Lithium; 50% (n=9) had depression, 44% (n=8) had bipolar affective disorder (BPAD) and 6% (n=1) schizoaffective disorder.78% (n= 14) of patients met the NICE standard of 3-monthly lithium level. Lithium levels were checkedon average 4.5 times in past year, average lithium level was 0.61mmol/L across the group and 39% (n=7) had lithium level within recommended therapeutic range (0.6-0.8mmol/L).83% of patients (n=15) met the NICE standards of 3 monthly renal tests. Taking into consideration mostrecent blood test results, 100% (n=18) had abnormal renal function.Half (n=9) were initiated on lithium by POA service and of these, 56% (n=5) had documented renal impairment prior to initiation. Of patients on long term lithium at time of referral (n=9), almost half (n=4) had a documented history of lithium toxicity.Conclusions:The results of this audit highlight room for improvement in lithium monitoring of older adults attending POA service. Furthermore, all patients prescribed lithium had impaired renal function. This is an important finding given the associations between those admitted to hospital with COVID-19 and co- morbid kidney disease and increased risk of inpatient death.Our findings highlight the need for three monthly renal function monitoring in elderly prescribed lithiumgiven the additive adverse effects of increasing age and lithium on the kidney. Close working with specialised renal services to provide timely advice on renal management for those with renal impairment prescribed lithium is important to minimise adverse patient outcomes.

scholarly journals Likelihood of Participation in Home-Based Cognitive Assessment: The Role of Subjective Cognitive Decline and Age

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 293-294
Author(s):  
Moriah Splonskowski ◽  
Holly Cooke ◽  
Claudia Jacova
Keyword(s):  
Older Adults ◽  
Cognitive Decline ◽  
Old Age ◽  
Cognitive Assessment ◽  
Community Dwelling ◽  
Subjective Cognitive Decline ◽  
Cognitive State ◽  
Home Based ◽  
Increased Risk

Abstract Home-based cognitive assessment (HBCA) services are emerging as a convenient alternative to in-clinic cognitive assessment and may aid in mitigating barriers to detecting cognitive impairment (CI). It is unknown which older adults would be likely to participate in HBCA. Here we investigated the role of age and Subjective Cognitive Decline (SCD). SCD has demonstrated an increased risk for progression to CI/dementia. A nation-wide community-dwelling sample of 494 adults age 50+ were recruited via Amazon Mechanical Turk to complete an online survey assessing perceptions around HBCA and SCD. Our sample was 91.9% White and 66.8% female. It consisted of 174 respondents aged 50-60, 265 aged 61- 70, and 55 aged 71-79. Age groups were comparable with respect to their acceptance of cognitive assessment (Range 4-20, higher score=higher acceptance, 7.9±3.3, 8.15±3.2, 8.05±3.43) and SCD-Q total (43.1±5.8, 43.2±5.7, 43.3±5.7). Correlation analysis revealed a relationship between SCD-QSCD total and perceived likelihood of participation in HBCA for those ages 61-70 (r(263) = .222 p = .000), but not for ages 50-60 or 71-79 (r(172) = .102 p = .152; r(53) = -.102 p = .458). Our findings suggest that SCD influences the likelihood of participation in HBCA for older adults’ transitioning to old age (61-70). Findings show that for adults transitioning into old age (61-70), perceived cognitive state influences their likelihood of participation in HBCA. Importantly, concerns about CI/dementia may generate more favorable perceptions of HBCA for this group.

scholarly journals Markers of Renal Function in Older Adults Completing a Higher Protein Obesity Intervention and One Year Later: Findings from the MEASUR-UP Trial

2018 ◽  
Vol 37 (2) ◽  
pp. 117-129 ◽  
Author(s):  
Kathryn N. Porter Starr ◽  
Shelley R. McDonald ◽  
Aubrey Jarman ◽  
Melissa Orenduff ◽  
Richard Sloane ◽  
...  
Keyword(s):  
Older Adults ◽  
Renal Function ◽  
Obesity Intervention ◽  
One Year

scholarly journals Ultra-Processed Food Consumption is Associated with Renal Function Decline in Older Adults: A Prospective Cohort Study

Nutrients ◽  
2021 ◽  
Vol 13 (2) ◽  
pp. 428
Author(s):  
Jimena Rey-García ◽  
Carolina Donat-Vargas ◽  
Helena Sandoval-Insausti ◽  
Ana Bayan-Bravo ◽  
Belén Moreno-Franco ◽  
...  
Keyword(s):  
Older Adults ◽  
Renal Function ◽  
Cohort Study ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Community Dwelling ◽  
Processed Food ◽  
Renal Function Decline ◽  
Increased Risk

Ultra-processed food (UPF) consumption has been associated with increased risk of cardiovascular risk factors and mortality. However, little is known on the UPF effect on renal function. The aim of this study is to assess prospectively the association between consumption of UPF and renal function decline. This is a prospective cohort study of 1312 community-dwelling individuals aged 60 and older recruited during 2008–2010 and followed up to December 2015. At baseline, a validated dietary history was obtained. UPF was identified according to NOVA classification. At baseline and at follow-up, serum creatinine (SCr) and estimated glomerular filtration rate (eGFR) levels were ascertained and changes were calculated. A combined end-point of renal decline was considered: SCr increase or eGFR decreased beyond that expected for age. Logistic regression with adjustment for potential confounders was performed. During follow-up, 183 cases of renal function decline occurred. The fully adjusted odds ratios (95% CI) of renal function decline across terciles of percentage of total energy intake from UPF were 1.56 (1.02–2.38) for the second tercile, and 1.74 (1.14–2.66) for the highest tercile; p-trend was 0.026. High UPF consumption is independently associated with an increase higher than 50% in the risk of renal function decline in Spanish older adults.

scholarly journals Therapy for persistent hypercalcemic hyperparathyroidism post-renal transplant: cinacalcet versus parathyroidectomy

2020 ◽  
Vol 42 (3) ◽  
pp. 315-322
Author(s):  
Gabriel Giollo Rivelli ◽  
Marcelo Lopes de Lima ◽  
Marilda Mazzali
Keyword(s):  
Renal Function ◽  
Renal Transplant ◽  
Serum Calcium ◽  
Laboratory Data ◽  
Renal Transplant Recipients ◽  
Therapeutic Modalities ◽  
Transplant Patients ◽  
Persistent Hyperparathyroidism ◽  
One Year

ABSTRACT Background: Persistent hyperparathyroidism post-transplant is associated with increases in the incidence of cardiovascular events, fractures, and deaths. The aim of this study was to compare both therapeutic options available: parathyroidectomy (PTX) and the calcimimetic agent cinacalcet. Methods: A single center retrospective study including adult renal transplant recipients who developed hypercalcemia due to persistent hyperparathyroidism. Inclusion criteria: PTH > 65 pg/mL with serum calcium > 11.5 mg/dL at any time after transplant or serum calcium persistently higher than 10.2 mg/dL one year after transplant. Patients treated with cinacalcet (n=46) were compared to patients treated with parathyroidectomy (n=30). Follow-up period was one year. Clinical and laboratory data were analyzed to compare efficacy and safety of both therapeutic modalities. Results: PTX controlled calcemia faster (month 1 x month 6) and reached significantly lower levels at month 12 (9.1±1.2 vs 9.7±0.8 mg/dL, p < 0.05); PTX patients showed significantly higher levels of serum phosphate (3.8±1.0 vs 2.9±0.5 mg/dL, p < 0.05) and returned PTH to normal levels (45±51 pg/mL). Cinacalcet, despite controlling calcium and phosphate in the long term, decreased but did not correct PTH (197±97 pg/mL). The proportion of patients that remained with PTH above normal range was 95% in the cinacalcet group and 22% in the PTX group. Patients treated with cinacalcet had better renal function (creatinine 1.2±0.3 vs 1.7±0.7 mg/dL, p < 0.05). Conclusions: Surgical treatment was superior to cinacalcet to correct the metabolic disorders of hyperparathyroidism despite being associated with worse renal function in the long term. Cinacalcet proved to be a safe and well tolerated drug.

scholarly journals Association of Serum Creatinine and Electrolyte Abnormalities in Preterm Low Birth Weight Neonates

2017 ◽  
Vol 26 (Number 1) ◽  
pp. 15-20
Author(s):  
Md. S Islam ◽  
M Bhuiyan ◽  
A S Chowdhury ◽  
ATM Rafique ◽  
M Afrin ◽  
...  
Keyword(s):  
Renal Failure ◽  
Renal Function ◽  
Birth Weight ◽  
Low Birth Weight ◽  
Renal Impairment ◽  
Serum Creatinine ◽  
Preterm Neonates ◽  
Close Monitoring ◽  
Increased Risk ◽  
Electrolyte Abnormalities

Introduction: Being born prematurely is a threat to survival and the subsequent quality of life ICDDR,B Health and Science Bulletin published in March 2006 reported that prematurity and low birth weight contributes to 27.8% of neonatal deaths in rural areas of Bangladesh Premature infant are at increased risk of developing dehydration or over hydration. Therefore, high index of suspicion, prompt recognition and thorough understanding of common electrolyte abnormalities are necessary to improve neonatal outcome. The investigation of renal function in pretenn neonate is complicated because of continuing renal development, rise in creatinine is transient and may not be clinically significcmt. Serum creatinine is most widely used marker of renal function in adults and children but its validity as a marker of GFR/ renal function is doubtful a few studies have been conducted on assessment of renal function and electrolytes in the context of prematurity in Bangladesh. But it seems to be essential for immediate management for planning appropriate fluid and electrolyte therapy and thereby for improved outcome. Information was collected who gave consent and participated in the study willingly. The sample size was 50. Duration of data collection was approximately 6 (Six) months.Patients admitted to the Holy Family Red Crescent Medical College and hospital and after meeting the inclusion and exclusion criteria a simple random sampling technique was applied for selecting the sample patients. Total 50 pretenn LBW neonates fulfilling the inclusion criteria were studied during this study period. Mean creatinine level was .82 mmoKrange was 0.40-1.90 mg/d1. Abnormal electrolytes were documented in 20(40%) pretenn LBW neonates of which hyperkalemia was the predominant electrolyte abnormality found in 8(16.0%) neonates, hyponatremia was found in 7 (14.0%), hypokalemia in 3 (6.0%) and hypernatremia 2 (4.0%). In the present study 20 of preterm LBW babies have electrolyte abnormalities. Hyperkalemia was found in 8(16.0%) babies in this study from above findings it is evident that prematurity causes transient renal impairment, in preterm neonates which is inversely related to gestational age. Renal impairment should be suspected if the serum creatinine rises or fails to show normal post-natal fall. It was observed that electrolyte abnormalities are common in preterm LBW neonates and transient renal failure also occurs in a large number of preterm LBW babies. So, identification of renal failure and associated electrolyte abnormalities and proper management of fluid and electrolytes and close monitoring are important.

scholarly journals Persistent Subclinical Hypothyroidism and Cardiovascular Risk in the Elderly: The Cardiovascular Health Study

2013 ◽  
Vol 98 (2) ◽  
pp. 533-540 ◽  
Author(s):  
Kristen A. Hyland ◽  
Alice M. Arnold ◽  
Jennifer S. Lee ◽  
Anne R. Cappola
Keyword(s):  
Older Adults ◽  
Thyroid Function ◽  
Subclinical Hypothyroidism ◽  
Cardiovascular Health ◽  
The Elderly ◽  
Health Study ◽  
Cardiovascular Health Study ◽  
Thyroid Function Tests ◽  
Function Tests ◽  
Increased Risk

Abstract Context: Use of a single set of thyroid function tests to define subclinical hypothyroidism may lead to misclassification over time and could influence findings from longitudinal studies. Objective: We assessed the risks of coronary heart disease (CHD), heart failure (HF), and cardiovascular (CV) death in older adults with persistent subclinical hypothyroidism. Design, Setting, and Participants: The study included 679 subclinically hypothyroid and 4184 euthyroid U.S. individuals at least 65 yr old enrolled in the Cardiovascular Health Study and not taking thyroid preparations. Main Outcome Measure: We measured the 10-yr risk of incident CHD, HF, and CV death from persistent subclinical hypothyroidism, overall and stratified by degree of TSH elevation (4.5–6.9, 7.0–9.9, and 10.0–19.9 mU/liter). Results: There was no association between persistent subclinical hypothyroidism and incident CHD [hazard ratio (HR), 1.12; 95% confidence interval (CI), 0.93–1.36], HF (HR, 1.05; 95% CI, 0.97–1.27), or CV death (HR, 1.07; 95% CI, 0.87–1.31) in adjusted analyses in which subclinical hypothyroidism was modeled as a time-varying exposure using up to four serial thyroid function tests. When subclinical hypothyroidism was stratified by degree of TSH elevation, no significant associations were found in any stratum. Findings were similar in fixed exposure analyses in which only participants with testing 2 yr apart were considered, with no association between persistent or transient subclinical hypothyroidism and incident CHD, HF, or CV death. Conclusions: Our data do not support increased risk of CHD, HF, or CV death in older adults with persistent subclinical hypothyroidism.

Anticoagulation in patients with impaired renal function and with haemodialysis

2015 ◽  
Vol 35 (01) ◽  
pp. 77-83 ◽  
Author(s):  
V. A.-T. Hentschel ◽  
S. Du ◽  
S. Zolfaghari ◽  
R. Krämer ◽  
C. Weiss ◽  
...  
Keyword(s):  
Renal Function ◽  
Renal Impairment ◽  
Impaired Renal Function ◽  
Vitamin K Antagonists ◽  
Oral Anticoagulants ◽  
Specific Treatment ◽  
Bleeding Risk ◽  
Bleeding Complications ◽  
Treatment Regimens ◽  
Increased Risk

SummaryPatients with impaired renal function are exposed to an increased risk for bleeding complications depending on the amount of the anticoagulant eliminated by the kidneys. The elimination of unfractionated heparins, vitamin K antagonists and argatroban is only minimally influenced by a reduced renal function. Low-molecular weight heparins, fondaparinux, danaparoid, hirudins and nonvitamin K antagonist oral anticoagulants (NOAC) cause a variably increased bleeding risk in renal impairment. Dose reductions are recommended for all of these anticoagulants in renal impairment, some are even contraindicated at certain levels of renal impairment. Their benefit over the conventional anticoagulants is preserved if renal dosing is employed. For end-stage renal disease patients specific treatment regimens are required.

scholarly journals The prevalence of urinary incontinence and its relationship with physical and cognitive status in older adults: Results of the Crystal and the Eucalipt studies

2021 ◽  
Vol 25 (2) ◽  
pp. 29-37
Author(s):  
Anna V. Turusheva
Keyword(s):  
Older Adults ◽  
Urinary Incontinence ◽  
Old Age ◽  
Protein Intake ◽  
Cognitive Status ◽  
Psychological State ◽  
Geriatric Syndromes ◽  
Sensory Deficits ◽  
Increased Risk ◽  
High Prevalence

BACKGROUND: Urinary incontinence worsens the psychological state of older adults, increases the risk of developing anxiety, depression, falls-related injuries, leads to a decrease in the quality of life, and a decrease in the level of physical activity in old age. AIM: To assess the prevalence of urinary incontinence according to the data of the Crystal and Eucalyptus studies, to identify factors associated with the development of urinary incontinence, as well as factors that reduce the risk of urinary incontinence in old age. MATERIALS AND METHODS: A random sample of 1007 people aged 65 and older. The main parameters: urinary incontinence, frailty, nutritional status, anemia, CRP, functional status, depression, dementia, chronic diseases, grip strength, level of physical functioning, falls. The observation time is 2.5 years. RESULTS: According to the Eucalyptus study, urinary incontinence syndrome was detected in 48.0%, in the Crystal study in 41.2%. In 62.4% cases urinary incontinence was diagnosed for the first time. Urinary incontinence was associated with a higher prevalence of COPD, history of stroke, sensory deficits, frailty and other geriatric syndromes. Improved nutrition and increased protein intake led to the disappearance of urinary incontinence complaints in 47.7% of cases. The disappearance of complaints of urinary incontinence was associated with an improvement in the emotional status. A decline in cognitive function has been associated with an increased risk of urinary incontinence in old age. CONCLUSIONS: Despite the high prevalence of urinary incontinence, it often remains undiagnosed. The correct wording of the question in the conversation with the patient allows to identify 30% more cases of urinary incontinence. Given the high prevalence of urinary incontinence among patients with COPD, stroke, sensory deficits, frailty and other geriatric syndromes, all patients in these groups should be purposefully asked about the presence of symptoms of urinary incontinence. Improved nutrition and increased protein intake are associated with the disappearance of urinary incontinence complaints.

scholarly journals Thyroid Function and Reduced Kidney Function with Aging in Chinese Older Adults: A Cross- sectional Study

2021 ◽  
Author(s):  
Lu Wei ◽  
Yun Bai ◽  
Yu Zhang ◽  
Zhenzhu Yong ◽  
Qun Zhang ◽  
...  
Keyword(s):  
Older Adults ◽  
Renal Function ◽  
Kidney Function ◽  
Thyroid Function ◽  
Older Individuals ◽  
Free Triiodothyronine ◽  
Older Population ◽  
Cross Sectional ◽  
Chinese Older Adults ◽  
Reduced Kidney Function

Abstract Background: Thyroid function may be a factor influencing renal function in general population. Renal function and thyroid function vary with aging, thus the association of thyroid function and declining kidney function in older adults was different from this in the young and remains controversial. The aim of this study was to estimate association between thyroid function in reference interval and reduced kidney function with aging in Chinese older adults.Methods: A total of 15729 adults, 23.3% (N= 3624) of which were older population, were collected in the health check-up department of the First Affiliated Hospital of Nanjing Medical University between January 2018 to January 2020.Basic demographic information was collected by physician-administered questionnaire. The variation tendency of thyroid function with aging was investigated by mean of free triiodothyronine (FT3), free thyroxine (FT4) and thyroid stimulatinghormone (TSH) in subgroups for every 10 years. Associations between kidney and thyroid function were estimated with β value by multiple linear regression and with odds ratio (OR) by multivariable logistic regression models adjusted for age, gender, body mass index and serum urine acid. Results: In the older population, an increased trend of TSH, a decreased trend of FT3 and little change of FT4 were identified with aging. Estimated glomerular filtration rate (eGFR) remarkably decreased with increasing TSH (β: -0.081) and declining FT3 (β: 0.083) concentrations. Compared with the population in the lowest FT3 quartile (3.10-4.45 pmol/L), the prevalence of eGFR< 75ml/min/1.73m2 significantly decreased by 22.0% with FT3 4.46-4.81 pmol/L, 27.6% with FT3 4.82-5.20 pmol/L and 34.9% with FT3 5.21-6.8 pmol/L in older individuals (P for trend <.001). The OR was 1.315 with high-normal TSH, comparing to low-normal TSH in older persons (P: 0.025). Similar results were found between prevalent eGFR< 60ml/min/1.73m2 and thyroid function. The prevalent reduced kidney function was not remarkably associated with FT4 in the reference range.Conclusions: This study demonstrated a significant association between thyroid function and kidney function, especially FT3 in older population. The clinician were advised to evaluate renal function with low-normal FT3 and high-normal TSH in case of potential decreased kidney function.

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