노인 환자의 항콜린성 약물 관련 요저류 발생 현황과 위험인자 분석
Analysis of Anticholinergic Drug-Induced Urinary Retention and Risk Factors in Older Patients
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Background : Anticholinergic drugs (ACDs) are used for treating various clinical conditions of the elderly. However, caution is needed due to their several central and peripheral adverse effects including urinary retention (UR). UR can extend hospitalization period and increase the burden of polypharmacy due to ureter catheter insertion or additional drug therapy. The aim of this study was to analyze current status of ACD-induced UR and risk factors in older patients. Methods : The study retrospectively reviewed patients aged 65 years and older who were first prescribed oral ACDs from July to September 2020. We measured anticholinergic burden using Korean Anticholinergic Burden Scale (KABS) and total number of ACDs. We also analyzed risk factors associated with UR. Results : Of a total of 1,883 patients, 115 (6.1%) patients developed UR. In the UR group, the KABS and total number of ACDs were significantly increased from the time of first administration to the time of UR (p < 0.001). They were not significantly different between UR and non-UR groups at the time of first administration. However, at the time of UR (last administration in the non-UR group), both were higher in the UR group (p < 0.001). Multivariate logistic regression analysis showed that age 85 years and older, male, Charlson Comorbidity Index of 3 and more, comorbidity related to UR, history of surgery, and the total number of ACDs were significant risk factors for UR. The odds ratio of UR was 4.84 in patients with two ACDs (95% CI: 2.57-9.09, p < 0.001) and 10.60 in those with three or more ACDs (95% CI: 4.27-26.30, p < 0.001) compared to patients with one ACD. Conclusion : High anticholinergic burden was associated with a higher incidence of UR. Therefore, pharmacist intervention is necessary to prevent UR adverse effects in the elderly who are taking multiple ACDs or in a high-risk group.
Abstract
Background : Anticholinergic drugs (ACDs) are used for treating various clinical conditions of the elderly. However, caution is needed due to their several central and peripheral adverse effects including urinary retention (UR). UR can extend hospitalization period and increase the burden of polypharmacy due to ureter catheter insertion or additional drug therapy. The aim of this study was to analyze current status of ACD-induced UR and risk factors in older patients. Methods : The study retrospectively reviewed patients aged 65 years and older who were first prescribed oral ACDs from July to September 2020. We measured anticholinergic burden using Korean Anticholinergic Burden Scale (KABS) and total number of ACDs. We also analyzed risk factors associated with UR. Results : Of a total of 1,883 patients, 115 (6.1%) patients developed UR. In the UR group, the KABS and total number of ACDs were significantly increased from the time of first administration to the time of UR (p < 0.001). They were not significantly different between UR and non-UR groups at the time of first administration. However, at the time of UR (last administration in the non-UR group), both were higher in the UR group (p < 0.001). Multivariate logistic regression analysis showed that age 85 years and older, male, Charlson Comorbidity Index of 3 and more, comorbidity related to UR, history of surgery, and the total number of ACDs were significant risk factors for UR. The odds ratio of UR was 4.84 in patients with two ACDs (95% CI: 2.57-9.09, p < 0.001) and 10.60 in those with three or more ACDs (95% CI: 4.27-26.30, p < 0.001) compared to patients with one ACD. Conclusion : High anticholinergic burden was associated with a higher incidence of UR. Therefore, pharmacist intervention is necessary to prevent UR adverse effects in the elderly who are taking multiple ACDs or in a high-risk group.
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