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Meta-Analysis
. 2024 Jun 1;5(6):841-850.
doi: 10.34067/KID.0000000000000447. Epub 2024 Apr 25.

Polypharmacy in Patients with CKD: A Systematic Review and Meta-Analysis

Ilse J Oosting  1   2 , Julia M T Colombijn  1   2 , Lotte Kaasenbrood  1 , Sophie Liabeuf  3   4 , Solène M Laville  3   4 , Lotty Hooft  2   5 , Michiel L Bots  2 , Marianne C Verhaar  1 , Robin W M Vernooij  1   2
Affiliations
Meta-Analysis

Polypharmacy in Patients with CKD: A Systematic Review and Meta-Analysis

Ilse J Oosting et al. Kidney360. .

Abstract

Key Points:

  1. The prevalence of polypharmacy in patients with CKD was over 80%.

  2. Polypharmacy was highest in patients with a kidney transplant and those receiving dialysis.

  3. Polypharmacy is associated with worse clinical outcomes, lower quality of life, and medication-related problems in patients with CKD.

Background: Despite the high prevalence of polypharmacy in patients with CKD, the extent of polypharmacy across patients with (different stages of) CKD, as well as the association with clinical outcomes remains unknown. This systematic review aimed to evaluate the prevalence of polypharmacy in (different subgroups of) patients with CKD and assess the association between polypharmacy and patient-important outcomes.

Methods: MEDLINE, Embase, and the Cochrane Library were searched from inception until July 2022. Studies that reported the prevalence of polypharmacy, medication use, or pill burden in patients with CKD (including patients receiving dialysis and kidney transplant recipients) and their association with patient-important outcomes (i.e., mortality, kidney failure, quality of life [QoL], and medication nonadherence) were included. Two reviewers independently screened title and abstract and full texts, extracted data, and assessed risk of bias. Data were pooled in a random-effects single-arm meta-analysis.

Results: In total, 127 studies were included (CKD 3–5 n=39, dialysis: n=38, kidney transplant n=13, different CKD stages n=37). The pooled prevalence of polypharmacy, based on 63 studies with 484,915 patients, across all patients with CKD was 82% (95% confidence interval, 76% to 86%), and the pooled mean number of prescribed medications was 9.7 (95% confidence interval, 8.4 to 11.0). The prevalence of polypharmacy was higher in patients who received dialysis or a kidney transplant compared with patients with CKD 3–5 but did not differ between studies with regards to region or patients' mean age or sex. In patients with CKD, polypharmacy was associated with a higher risk of all-cause mortality, kidney failure, faster eGFR decline, lower QoL, and higher medication nonadherence, adverse drug reactions, and potentially inappropriate medications.

Conclusions: The prevalence of polypharmacy in patients with CKD was over 80%, and highest in patients with a kidney transplant and those receiving dialysis. No causes of heterogeneity were identified, indicating that polypharmacy is an issue for all patients with CKD. Polypharmacy is associated with worse clinical outcomes, lower QoL, and medication-related problems in patients with CKD.

Clinical Trial registry name and registration number:: PROSPERO (CRD42022331941).

PubMed Disclaimer

Conflict of interest statement

Disclosure forms, as provided by each author, are available with the online version of the article at http://links.lww.com/KN9/A496.

Figures

None
Graphical abstract
Figure 1
Figure 1
Meta-analysis of the prevalence of polypharmacy stratified for CKD stage. CI, confidence interval.
Figure 2
Figure 2
Meta-analysis of the prevalence of hyperpolypharmacy stratified for CKD stage.
Figure 3
Figure 3
Forest plots pooled analysis patient-important outcomes. ADR, adverse drug reaction.
See this image and copyright information in PMC

References

    1. Jager KJ, Kovesdy C, Langham R, Rosenberg M, Jha V, Zoccali C. A single number for advocacy and communication-worldwide more than 850 million individuals have kidney diseases. Kidney Int. 2019;96(5):1048–1050. doi:10.1016/j.kint.2019.07.012 - DOI - PubMed
    1. Wang J Zhang L Tang SC-w, et al. .; ISN North and East Asia Regional Board. Disease burden and challenges of chronic kidney disease in North and East Asia. Kidney Int. 2018;94(1):22–25. doi:10.1016/j.kint.2017.12.022 - DOI - PubMed
    1. Jha V, Wang AY-M, Wang H. The impact of CKD identification in large countries: the burden of illness. Nephrol Dial Transplant. 2012;27(suppl 3):iii32–iii38. doi:10.1093/ndt/gfs113 - DOI - PubMed
    1. Mills KT Xu Y Zhang W, et al. . A systematic analysis of worldwide population-based data on the global burden of chronic kidney disease in 2010. Kidney Int. 2015;88(5):950–957. doi:10.1038/ki.2015.230 - DOI - PMC - PubMed
    1. Tonelli M, Riella MC. Chronic kidney disease and the aging population. Kidney Int. 2014;85(3):487–491. doi:10.1038/ki.2013.467 - DOI - PubMed