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

Abstract

\n \n \n This study aims to examine polypharmacy prevalence in patients with CKD stage G4/G5, and patients with kidney replacement therapy (KRT), in comparison to matched controls from the general population. Furthermore, we examine risk factors for polypharmacy and describe the most commonly dispensed medications.\n \n \n \n Dutch health claims data was used to identify 3 patient groups, i.e. CKD stage G4/G5, dialysis, and kidney transplant patients. Each patient was matched to two controls based on matched for age, sex and SES score. We differentiated between all medication use and chronic medication use. Polypharmacy was defined at three levels: use of\u2009≥\u20095 medications (polypharmacy, PP), ≥10 medications (excessive polypharmacy, EPP), and ≥15 medications (hyperpolypharmacy, HPP).\n \n \n \n . 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 (aged 20-44 years) than in controls, while this ratio was 3.8 in patients ≥75 years. Older age (64-75 years and ≥75 years) was a risk factor for polypharmacy in CKD stage G4/G5 and kidney transplant patients. Dialysis patients aged ≥75 years had a lower risk of polypharmacy compared to their younger counterparts. Additional risk factors in all patients were low socioeconomic status, diabetes mellitus, vascular disease, hospitalization, and an emergency room visit. Most commonly dispensed medications were proton pump inhibitors (PPIs) and statins.\n \n \n \n CKD stage G4/G5 patients and patients with KRT have a high medication burden, far beyond that of individuals from the general population, as a result of their kidney disease and 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 steps towards a more appropriate medication use.\n