Drug utilization in patients starting haemodialysis with a focus on cardiovascular and antidiabetic medications: an epidemiological study in the Lazio region (Italy), 2016-2020

Abstract

Background: Entering dialysis is a critical moment in patients' healthcare journey, and little is known about drug therapy around it. A study funded by the Italian Medicines Agency offered the opportunity to leverage data from the Lazio Regional Dialysis and Transplant Registry (RRDTL) and perform an observational study on drug use patterns before and after initiating chronic dialysis.

Methods: Individuals initiating dialysis in 2016-2020 were identified from RRDTL, excluding patients with prior renal transplantation, stopping dialysis early, or dying within 12 months. Use of study drugs, predefined by clinicians, in the two years around the index date was retrieved from the drug claims register and described by semester. For each drug group, proportions of users (min 2 claims in 6 months) by semester, and intensity of treatment in terms of Defined Daily Doses (DDDs) for cardiovascular and antidiabetic agents were compared across semesters, stratifying by sex and age.

Results: In our cohort of 3,882 patients we observed a general increase in drug use after initiating dialysis, with the mean number rising from 5.5 to 6.2. Cardiovascular agents accounted for the highest proportions, along with proton pump inhibitors and antithrombotics over all semesters. Dialysis-specific therapies showed the most evident increase, in particular anti-anaemics (iron 4-fold, erythropoietins almost 2-fold), anti-parathyroids (6-fold), and chelating agents (4-fold). Use of cardiovascular and antidiabetic drugs was characterised by significant variations in terms of patterns and intensity, with some differences between sexes and age groups.

Conclusions: Entering dialysis is associated with increased use of specific drugs and goes along with adaptations of chronic therapies.

Keywords: Cardiovascular; Diabetes; Dialysis; Drug therapy; Observational study.

Fig. 1

Attrition diagram of the cohort selection

Fig. 2

Proportions of haemodialysis patients using study drugs in the four semesters around dialysis start

Fig. 3

Proportions of patients using antidiabetics in the semesters around dialysis start by sex and age

Fig. 4

Intensity of therapy with diuretics, ACEIs/ARBs, and antidiabetics in the four semesters

Fig. 5

Intensity of antidiabetic therapy in the four semesters by sex and age