This article was downloaded by: [University of Otago] On: 19 July 2015, At: 11:38 Publisher: Taylor & Francis Informa Ltd Registered in England and Wales Registered Number: 1072954 Registered office: 5 Howick Place, London, SW1P 1WG
Postgraduate Medicine Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/ipgm20
Impact of renal aging on drug therapy a
b
b
c
Carlos G. Musso , Waldo H. Belloso , Paula Scibona , Vincenzo Bellizzi & Juan F. Macías Núñez
d
a 1
Nephrology Division, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
b 2
Clinical Pharmacology Section of Internal Medicine Service, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina c 3
Nephrology and Dialysis Unit, Polla Hospital, Salerno, Italy
d 4
Nephrology Division, Hospital Universitario de Salamanca, Salamanca, Spain Published online: 11 Jul 2015.
To cite this article: Carlos G. Musso, Waldo H. Belloso, Paula Scibona, Vincenzo Bellizzi & Juan F. Macías Núñez (2015): Impact of renal aging on drug therapy, Postgraduate Medicine To link to this article: http://dx.doi.org/10.1080/00325481.2015.1063957
PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms & Conditions of access and use can be found at http:// www.tandfonline.com/page/terms-and-conditions
http://informahealthcare.com/pgm ISSN: 0032-5481 (print), 1941-9260 (electronic) Postgrad Med, 2015; Early Online: 1–7 DOI: 10.1080/00325481.2015.1063957
CLINICAL FEATURE REVIEW
Impact of renal aging on drug therapy Carlos G. Musso1, Waldo H. Belloso2, Paula Scibona2, Vincenzo Bellizzi3 and Juan F. Macías Núñez4 Nephrology Division, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina, 2Clinical Pharmacology Section of Internal Medicine Service, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina, 3Nephrology and Dialysis Unit, Polla Hospital, Salerno, Italy, and 4Nephrology Division, Hospital Universitario de Salamanca, Salamanca, Spain
Downloaded by [University of Otago] at 11:38 19 July 2015
1
Abstract
Keywords:
Elderly patients (age ‡ 65 years old) use up to 30% of all commonly prescribed medication, and they suffer more their adverse effects than the general population. In order to minimize this risk, physicians should avoid polypharmacy, dangerous pharmacological interactions and take into account pharmacodynamic and senile pharmacokinetic changes before prescribing any medication to the elderly. The present review article originally describes how renal physiology changes secondary to aging such as dysautonomia, glomerular filtration rate reduction, tubular back-filtration, sodium, calcium and magnesium loss, potassium retention, altered dilutionconcentration capability, tubular frailty, genetics, internal milieu and body composition are senile changes that when combined predispose elderly people to suffer from pharmacological adverse effects. Knowledge of these physiological modifications associated with aging and their impact on the pharmacology of particular drugs may help to optimize drug use and to avoid complications in this age group.
Aging, kidney, pharmacology, renal function, dosing
Introduction Elderly people (age ‡65 years) represent around 12% of the western population, and this group of senile individuals is currently divided by gerontologists into two subgroups: old people (age ‡65 and
Postgraduate Medicine Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/ipgm20
Impact of renal aging on drug therapy a
b
b
c
Carlos G. Musso , Waldo H. Belloso , Paula Scibona , Vincenzo Bellizzi & Juan F. Macías Núñez
d
a 1
Nephrology Division, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
b 2
Clinical Pharmacology Section of Internal Medicine Service, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina c 3
Nephrology and Dialysis Unit, Polla Hospital, Salerno, Italy
d 4
Nephrology Division, Hospital Universitario de Salamanca, Salamanca, Spain Published online: 11 Jul 2015.
To cite this article: Carlos G. Musso, Waldo H. Belloso, Paula Scibona, Vincenzo Bellizzi & Juan F. Macías Núñez (2015): Impact of renal aging on drug therapy, Postgraduate Medicine To link to this article: http://dx.doi.org/10.1080/00325481.2015.1063957
PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms & Conditions of access and use can be found at http:// www.tandfonline.com/page/terms-and-conditions
http://informahealthcare.com/pgm ISSN: 0032-5481 (print), 1941-9260 (electronic) Postgrad Med, 2015; Early Online: 1–7 DOI: 10.1080/00325481.2015.1063957
CLINICAL FEATURE REVIEW
Impact of renal aging on drug therapy Carlos G. Musso1, Waldo H. Belloso2, Paula Scibona2, Vincenzo Bellizzi3 and Juan F. Macías Núñez4 Nephrology Division, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina, 2Clinical Pharmacology Section of Internal Medicine Service, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina, 3Nephrology and Dialysis Unit, Polla Hospital, Salerno, Italy, and 4Nephrology Division, Hospital Universitario de Salamanca, Salamanca, Spain
Downloaded by [University of Otago] at 11:38 19 July 2015
1
Abstract
Keywords:
Elderly patients (age ‡ 65 years old) use up to 30% of all commonly prescribed medication, and they suffer more their adverse effects than the general population. In order to minimize this risk, physicians should avoid polypharmacy, dangerous pharmacological interactions and take into account pharmacodynamic and senile pharmacokinetic changes before prescribing any medication to the elderly. The present review article originally describes how renal physiology changes secondary to aging such as dysautonomia, glomerular filtration rate reduction, tubular back-filtration, sodium, calcium and magnesium loss, potassium retention, altered dilutionconcentration capability, tubular frailty, genetics, internal milieu and body composition are senile changes that when combined predispose elderly people to suffer from pharmacological adverse effects. Knowledge of these physiological modifications associated with aging and their impact on the pharmacology of particular drugs may help to optimize drug use and to avoid complications in this age group.
Aging, kidney, pharmacology, renal function, dosing
Introduction Elderly people (age ‡65 years) represent around 12% of the western population, and this group of senile individuals is currently divided by gerontologists into two subgroups: old people (age ‡65 and
