A population-based study on the association between acute renal failure (ARF) and the duration of polypharmacy

Abstract

BackgroundBecause of the rapid growth in elderly population, polypharmacy has become a serious public health issue worldwide. Although acute renal failure (ARF) is one negative consequence of polypharmacy, the association between the duration of polypharmacy and ARF remains unclear. We therefore assessed this association using a population-based database.MethodsData were collected from the Taiwan National Health Insurance Research Database (NHIRD) from 2003 through 2006. The case group included patients hospitalized for ARF during 2006, but not admitted due to trauma, surgery, burn trauma, car accident, transplantation, or infectious diseases; the control group included patients hospitalized without ARF. The cumulative number of days of polypharmacy (defined as more than 5 prescriptions per day) for 1 year prior to admission was determined, with patients further subdivided into 4 categories: less than 30 days, 31–90 days, 91–180 days, and over 181 days. The dependent variable was ARF, and the control variables were age, gender, comorbidities in patients hospitalized for ARF, stay in ICUs during ARF hospitalization and site of operation for prior admissions within one month of ARF hospitalization.ResultsOf 20,790 patients who were admitted to hospitals for ARF in 2006, 12,314 (59.23 %) were male and more than 60 % were older than 65 years. Of patients with and without ARF, 16.14 % and 10.61 %, respectively, received polypharmacy for 91–180 days and 50.22 % and 24.12 %, respectively, for over 181 days. A statistical model indicated that, relative to patients who received polypharmacy for less than 30 days, those who received polypharmacy for 31–90, 91–180 and over 181 days had odds ratios of developing ARF of 1.33 (p<0.001), 1.65 (p<0.001) and 1.74 (p<0.001), respectively.ConclusionsWe observed statistically significant associations between the duration of polypharmacy and the occurrence of ARF.

Characteristics of doctor-shoppers: a systematic literature review

“…Doctor-shopping can signal problems of healthcare system and drug overuse resulting in worsening of health condition of doctor-shoppers. A negative impact of polypharmacy on health has been well documented in the literature [49]. Also, changing doctors reduces continuity of care which can translate into worse disease management and increased waiting times as well as increased cost of treatment for both the patients and payers [50].…”

The drugs that mostly frequently induce acute kidney injury: a case − noncase study of a pharmacovigilance database

“…In one study, it was shown that the simultaneous administration of at least two cardiovascular drugs (antihypertensive agents, antiarrhythmic agents, diuretics, platelet aggregation inhibitors, lipid‐lowering agents and digoxin) was significantly associated with an increased risk of AKI . Similarly, a study of the large Taiwan National Health Insurance Research Database found that polypharmacy for 31–90 days, 91–180 days and over 181 days was respectively associated with odds ratios for developing acute kidney failure of 1.33 ( P < 0.001), 1.65 ( P < 0.001) and 1.74 ( P < 0.001), when compared with polypharmacy for less than 30 days .…”

The Perfect Storm

“…Polypharmacy has been linked to poor health outcomes in this population including increased risk for AKI, falls, and functional decline. 14,15 Each of these potential causes of AKI is discussed in the following section of this paper.…”

“…15 Polypharmacy is emerging as a significant contributor to poor health outcomes in older adults such as increased risk of hospitalization, greater chance of adverse drug reactions, and higher health care costs. 21,22 The most frequent adverse drug reaction in critical care is drug-induced AKI, and cardiovascular medications pose the highest risk.…”

“…24,25 The true impact of polypharmacy may not be known because of inconsistent definition and measurement of polypharmacy across studies. 15 Commonly, polypharmacy is defined by the number of medications a person is taking. What constitutes too many or not enough drugs often poses a dilemma for clinicians, so a better definition of polypharmacy, such as appropriate prescribing of multiple medications or the inappropriate prescribing of multiple medications, may help optimize prescribing in older adults.…”