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. 2021 Jul 6;14(12):2497-2523.
doi: 10.1093/ckj/sfab120. eCollection 2021 Dec.

Polypharmacy and medication use in patients with chronic kidney disease with and without kidney replacement therapy compared to matched controls

Manon J M van Oosten  1 , Susan J J Logtenberg  2 , Marc H Hemmelder  3 , Martijn J H Leegte  4 , Henk J G Bilo  5 , Kitty J Jager  1 , Vianda S Stel  1
Affiliations

Polypharmacy and medication use in patients with chronic kidney disease with and without kidney replacement therapy compared to matched controls

Manon J M van Oosten et al. Clin Kidney J. .

Abstract

Background: This study aims to examine polypharmacy (PP) prevalence in patients with chronic kidney disease (CKD) Stage G4/G5 and patients with kidney replacement therapy (KRT) compared with matched controls from the general population. Furthermore, we examine risk factors for PP and describe the most commonly dispensed medications.

Methods: Dutch health claims data were used to identify three patient groups: CKD Stage G4/G5, dialysis and kidney transplant patients. Each patient was matched to two controls based on age, sex and socio-economic status (SES) score. We differentiated between 'all medication use' and 'chronic medication use'. PP was defined at three levels: use of ≥5 medications (PP), ≥10 medications [excessive PP (EPP)] and ≥15 medications [hyper PP (HPP)].

Results: The PP prevalence for all medication use was 87, 93 and 95% in CKD Stage G4/G5, dialysis and kidney transplant patients, respectively. For chronic medication use, this was 66, 70 and 75%, respectively. PP and comorbidity prevalence were higher in patients than in controls. EPP was 42 times more common in young CKD Stage G4/G5 patients (ages 20-44 years) than in controls, while this ratio was 3.8 in patients ≥75 years. Older age (64-75 and ≥75 years) was a risk factor for PP in CKD Stage G4/G5 and kidney transplant patients. Dialysis patients ≥75 years of age had a lower risk of PP compared with their younger counterparts. Additional risk factors in all patients were low SES, diabetes mellitus, vascular disease, hospitalization and an emergency room visit. The most commonly dispensed medications were proton pump inhibitors (PPIs) and statins.

Conclusions: CKD Stage G4/G5 patients and patients on KRT have a high medication burden, far beyond that of individuals from the general population, as a result of their kidney disease and a large burden of comorbidities. A critical approach to medication prescription in general, and of specific medications like PPIs and statins (in the dialysis population), could be a first step towards more appropriate medication use.

Keywords: CKD; dialysis; health claims data; kidney transplantation; medication use; polypharmacy.

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Figures

Graphical Abstract
Graphical Abstract
FIGURE 1:
FIGURE 1:
Flow chart study participants
FIGURE 2:
FIGURE 2:
Total number of dispensed medication per percentage of CKD stage G4/G5 not on KRT patients, dialysis and kidney transplant patients versus matched controls; all medication use
FIGURE 3:
FIGURE 3:
Total number of dispensed medication per percentage of CKD stage G4/G5 not on KRT patients, dialysis and kidney transplant patients versus matched controls; chronic medication use
FIGURE 4:
FIGURE 4:
Percentage and ratio of polypharmacy of CKD stage G4/G5 without KRT, dialysis and kidney transplant patients versus matched controls for (left) all medication use and (right) chronic medication use
See this image and copyright information in PMC

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