Evaluation of Changes Over Time in the Drug Burden and Medication Regimen Complexity in ESRD Patients Before and After Renal Transplantation

Abstract

Background: Medication regimen complexity (MRC) has not been characterized in detail in patients with end-stage renal disease (ESRD). The objective of the present study was to quantify changes over time in the prescription drug burden and MRC in patients with ESRD (before transplantation, on discharge after kidney transplantation [M0], and 4 months [M4] and 12 months [M12] afterward).Methods: We retrospectively studied adult patients having undergone kidney transplantation. The number and types of drug prescribed, the pill burden, and the MRC index (MRCI) at 4 different time points (before transplantation, M0, M4, and M12) were extracted from the patients' medical records. MRCI was calculated by adding each drug score (calculated according to its formulation, dosing frequency, and additional instructions concerning administration). Hence, the MRCI took account of all prescription drugs. A logistic regression model was used to identify factors associated with an elevated MRCI at M12. Results:The median (interquartile range) age of the 354 study participants was 52 years (42-62). Respectively 21%, 42%, 53%, and 38% of the patients were taking 10 or more drugs before transplantation and at M0, M4, and M12. At M12, the 3 most frequently prescribed drug classes were immunosuppressants, cardiovascular system drugs, and drugs acting on the alimentary tract and metabolism. The pill burden and MRCI before transplantation were significantly lower (P < 0.001) than at each time point after transplantation. Diabetes and dyslipidemia were independently associated with an elevated MRCI at M12. Conclusion:In kidney transplant recipients, the drug burden and MRCI were greater at all time points after transplantation than before transplantation. The impact of the drug burden and MRC on medication adherence and clinical outcomes in these patients requires further evaluation.

The Prescription of Drugs That Inhibit Organic Anion Transporters 1 or 3 Is Associated with the Plasma Accumulation of Uremic Toxins in Kidney Transplant Recipients

“…The estimated glomerular filtration rate (eGFR) partly recovers after transplantation, which decreases plasma PBUT concentrations [8]. Kidney transplant recipients take a mean ± standard deviation of 11 ± 3 drugs and thus have a higher, more complex drug burden than hemodialyzed patients [9]. This polypharmacy results in a greater frequency of adverse drug reactions [10] and thus might increase pharmacokinetic interactions between drugs and UTs.…”

Chronic kidney disease and neurological disorders: are uraemic toxins the missing piece of the puzzle?

“…In patients with CKD, poor drug clearance and greater drug penetration through the blood-brain barrier (BBB) might lower the threshold for neurotoxicity and contribute to cognitive dysfunction. Indeed, most patients with CKD take several medications on a daily basis [26][27][28].…”

Evaluating the Association and Predictability of Complex Medication Regimen Scores with Clinical Outcomes Among the Critically Ill

“…Yet, the most commonly utilized and validated objective scoring tool is the 65-item, weighted MRC index (MRCI) which has been developed for outpatient use [12][13][14][15][16]. MRCI has been used to evaluate conditions such as neurological impairment in children, hypertension, diabetes, and chronic kidney disease in adults [17][18][19][20][21]. In the intensive care unit (ICU) population, the MRC in ICU (MRCICU) scoring tool was developed and revised (modified MRCICU) in 2019 [22,23].…”