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Medication burden high in patients with CKD
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SAN DIEGO — Polypharmacy was prevalent in patients with chronic kidney disease, according to data presented at ASN Kidney Week 2018.
“We were interested in getting to know more about the patterns of medication use and the burden of polypharmacy in patients with CKD because there are not a lot of studies examining this topic so far,” Insa Marie Schmidt, MD, from the Harvard School of Public Health, told Healio Nephrology. “We expected that there was a high burden and examined whether medication was properly dosed and what kind of medications were received.”
Schmidt and colleagues analyzed data from a longitudinal, multicenter study, known as the German Chronic Kidney Disease study, in patients with CKD aged between 18 and 74 years (n = 5,217) to examine drug use trajectories and prevalence and risk factors of polypharmacy. Polypharmacy was defined as the use of five or more drugs per day.
Participants were followed for 4 years and included those with an estimated glomerular filtration rate (eGFR) between 30 and 60 mL/min/1.73m² or an eGFR of 60 ml/min/1.73m² and overt proteinuria (more than 500 mg per day).
The researchers found polypharmacy was prevalent in nearly 80% of patients with CKD, ranging from 62% in patients with an eGFR greater than 90 ml/min/1.73m² to 86% in those with an eGFR between 30 and 45 mL/min/1.73m². On average, participants took seven medications per day. The most common medications used were beta blockers, ACE inhibitors and statins.
Polypharmacy was more common in females and participants with a lower educational level. There was a significant association between the prevalence of polypharmacy and the maintenance of polypharmacy over time and increasing CKD stage, age, BMI, diabetes mellitus, cardiovascular disease and a history of smoking. A significant risk factor for the initiation of polypharmacy in CKD patients was comorbid diabetes mellitus.
“We need more research to address these implications of polypharmacy because we believe it might have a negative impact on adherence to medication in these patients,” Schmidt said. “We also need to further explore the risk/benefit ratio for the entirety of these prescribed drugs.”
“To reduce polypharmacy in patients with CKD, we need to develop tools with pharmacists that go through the charts and really see if medications are being properly used and if we can reduce a few medications. We also need guidelines to be more specific,” she said. by Alaina Tedesco
Reference:
Schmidt IM, et al. Abstract TH-PO1072. Presented at: ASN Kidney Week; Oct. 23-28, 2018; San Diego.
Disclosure: Healio Nephrology was unable to confirm relevant financial disclosures at the time of publication.