Are Older Adults with Chronic Kidney Disease Receiving the Correct Gabapentinoid Dose Based on Creatinine Clearance?

Introduction:
Chronic Kidney Disease (CKD) affects around 10% of the Scottish population and is particularly prevalent among older adults. As renal function declines with age, drug clearance decreases, increasing the risk of systemic toxicity. Gabapentin and pregabalin, commonly used for neuropathic pain in older adults, are renally excreted and can accumulate, leading to sedation, confusion, and falls. Appropriate dose adjustment according to creatinine clearance (CrCl) is therefore essential. Despite national guidance from NICE, BNF, and SIGN, dosing errors in renal impairment remain a concern in general practice. This audit evaluated adherence to gabapentinoid dosing guidelines for patients with CKD in a rural Scottish general practice.

Methods:
A retrospective review of electronic health records (EMIS and Docman) was conducted at Coast Health Practice, Fife. Fourteen patients with CKD prescribed gabapentinoids were identified, with nine meeting the inclusion criteria. For included patients, CrCl was calculated using the Cockcroft–Gault equation. Prescribed doses were compared against BNF renal dosing recommendations. Statistical analysis was performed using SPSS, with a Mann–Whitney test applied to compare prescribed and recommended doses.

Results:
Of the fourteen patients audited, one (11%) received an incorrect total daily dose, and one had an inappropriate dosing frequency. Statistical analysis (p = 0.696) showed no significant difference between prescribed and recommended doses, indicating overall adherence to guidance.

Conclusion:

While most patients received appropriate gabapentinoid doses at this rural practice, a small proportion were prescribed incorrect doses or dosing frequencies, highlighting potential risks of systemic toxicity. The findings emphasise the value of regular prescribing reviews and clinician education on CrCl-based dose adjustment in older adults with CKD, supporting safer prescribing in community settings. Implementing CrCl-based electronic alerts within EMIS could further strengthen safe gabapentinoid prescribing, preventing adverse effects and functional decline in older adults with CKD.