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. 2018 Aug;35(8):735-750.
doi: 10.1007/s40266-018-0563-1.

Kidney Function, Polypharmacy, and Potentially Inappropriate Medication Use in a Community-Based Cohort of Older Adults

Alex Secora  1   2   3 , G Caleb Alexander  4   5   6 , Shoshana H Ballew  4   7 , Josef Coresh  4   7 , Morgan E Grams  4   7   5   8
Affiliations

Kidney Function, Polypharmacy, and Potentially Inappropriate Medication Use in a Community-Based Cohort of Older Adults

Alex Secora et al. Drugs Aging. 2018 Aug.

Abstract

Background: Chronic kidney disease (CKD) afflicts many older adults and increases the risk for medication-related adverse events.

Objective: The aim of this study was to assess the prevalence and associated morbidity and mortality of polypharmacy (use of several medications concurrently), and potentially inappropriate medication (PIM) use in older adults, looking for differences by CKD status.

Methods: We quantified medication and PIM use (from Beers criteria, the Screening Tool of Older People's Prescriptions, and Micromedex®) by level of estimated glomerular filtration rate (eGFR) for participants aged 65 years or older attending a baseline study visit in the Atherosclerosis Risk in Communities study (n =6392). We used zero-inflated negative binomial and Cox proportional hazards regressions to assess the relationship between baseline polypharmacy, PIM use, and subsequent hospitalization and death.

Results: Mean age at baseline was 76 (± 5) years, 59% were female, and 29% had CKD (eGFR < 60 ml/min/1.73 m2). Overall, participants reported 6.1 (± 3.5) medications and 2.3 (± 2.2) vitamins/supplements; 16% reported ≥ 10 medications; 31% reported a PIM based on their age. On average, participants with CKD reported more medications. A PIM based on kidney function was used by 36% of those with eGFR < 30 ml/min/1.73 m2. Over a median of 2.6 years, more concurrent medications were associated with higher risk of hospitalization and death, but PIM use was not. While those with CKD had higher absolute risks, there was no difference in the relative risks associated with greater numbers of medications by CKD status.

Conclusion: Polypharmacy and PIM use were common, with greater numbers of medications associated with higher risk of hospitalization and death; relative risks were similar for those with and without CKD.

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Conflict of interest statement

Conflicts of interest:

Dr. Alexander is Chair of FDA’s Peripheral and Central Nervous System Advisory, Committee, has served as a paid advisor to IQVIA, serves on the advisory board of, MesaRx Innovations, is a member of OptumRx’s National P&T Committee; and holds, equity in Monument Analytics, a health care consultancy whose clients include the life, sciences industry as well as plaintiffs in opioid litigation. This arrangement has been reviewed and approved by Johns Hopkins University in accordance with its conflict of interest policies. Alex Secora, G. Caleb Alexander, Shoshana Ballew, Josef Coresh and Morgan Grams declare that they have no conflicts of interest relevant to the content of, this study.

Figures

Figure 1
Figure 1. Proportion of participants reporting at least one medication in the prior 30 days, by category of medications
Categorized by estimated glomerular filtration rate (eGFR); units in mL/min/1.73m2 Key: Nonsteroidal anti-inflammatory drug (NSAID); Angiotensin-converting-enzyme (ACE) inhibitor or ACE combination product; Angiotensin II receptor blockers (ARB) or ARB combination product; Antihypertensive includes diuretics, beta-blockers, calcium channel blockers, ACE/combination, and ARB/combination
Figure 2
Figure 2. Risk of hospitalization across total number of medications
Key: Histogram depicts the distribution of total number of medications in the cohort (right y-axis). The solid black line (black dashed lines are 95% confidence interval) is the adjusted incidence rate ratio, representing the average (covariates were centered at cohort means) participant’s risk of hospitalization across total number of medications, relative to the reference (4 medications). Model was adjusted for estimated glomerular filtration rate, hypertension, cardiovascular disease, diabetes, heart failure, self-reported myocardial infarction, Charlson Comorbidity Index, frailty, sex, race, Age, Body Mass Index, current smoking status, current alcohol use, Mini-Mental State Evaluation, high-density lipoproteins, low-density lipoproteins, triglycerides, and total vitamins/supplements.
Figure 3
Figure 3. Risk of death across total number of medications
Key: Histogram depicts the distribution of total number of medications in the cohort (right y-axis). The solid black line (black dashed lines are 95% confidence interval) is the adjusted hazard ratio, representing the average (covariates were centered at cohort means) participant’s risk of death across total number of medications, relative to the reference (4 medications). Model was adjusted for estimated glomerular filtration rate, hypertension, cardiovascular disease, diabetes, heart failure, self-reported myocardial infarction, Charlson Comorbidity Index, frailty, sex, race, age, Body Mass Index, current smoking status, current alcohol use, Mini-Mental State Evaluation, high-density lipoproteins, low-density lipoproteins, triglycerides, and total vitamins/supplements.
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