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

Oosten, Manon J M van; Logtenberg, S. J. J.; Hemmelder, Marc H; Leegte, Martijn; Bilo, Henk J. G.; Jager, Kitty J.; Stel, Vianda S.

doi:10.1093/ckj/sfab120

Cited by 23 publications

(39 citation statements)

References 46 publications

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“…12) However, more medications are usually prescribed in patients undergoing HD; thus, 10 or more medications were defined as excessive polypharmacy in the patients undergoing HD in previous studies. 18,19) In older patients in this study, 94.0% of the patients took 5 or more drugs, and 55.8% of patients took 10 or more drugs; the average number of prescribed medications was approximately 10. This finding suggests that polypharmacy is common in older patients undergoing HD.…”

Section: Discussionmentioning

confidence: 69%

Anorexia Assessed by Simplified Nutritional Appetite Questionnaire and Association with Medication in Older Patients Undergoing Hemodialysis

Notomi¹,

Kitamura²,

Yamaguchi

et al. 2023

Biological & Pharmaceutical Bulletin

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Anorexia is a common symptom in older patients undergoing hemodialysis (HD) and has become a serious problem in dialysis facilities with the aging of patients. Polypharmacy, defined as the prescription of several medications, is known to cause drug-induced anorexia. Although polypharmacy is also common in older patients undergoing HD, only a few studies have examined the association between anorexia and polypharmacy. This study used the Simplified Nutritional Appetite Questionnaire for Japanese Elderly (SNAQ-JE) to evaluate patients' appetite, and examined its association with medications. This cross-sectional study included 233 patients (aged ≥65 years) who underwent HD in October 2021. Among the 233 patients (median age, 73.0 [interquartile range (IQR), 69.0-80.5] years; men, 57.3%; median dialysis vintage, 62.0 [IQR, 30.0-122.0] months), 116 and 117 were classified into the poor (SNAQ-JE total score ≤14) and good (>14) appetite groups, respectively. Although the total number of medications prescribed was not significantly different between the two groups (p 0.12), the number of antihypertensive drugs was significantly lower ( p 0.03), and that of sleeping medications was significantly higher (p 0.002) in the poor appetite group. Multivariable logistic regression analysis showed that the number of sleeping medications was associated with poor appetite (odds ratio, 2.08; 95% confidence interval, 1.32-3.27; p < 0.001). The findings suggest that the number of sleeping medications is an important contributing factor to poor appetite in older patients undergoing HD. A proper and regular review of prescriptions may be necessary to improve anorexia.

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Section: Discussionmentioning

confidence: 69%

Anorexia Assessed by Simplified Nutritional Appetite Questionnaire and Association with Medication in Older Patients Undergoing Hemodialysis

Notomi¹,

Kitamura²,

Yamaguchi

et al. 2023

Biological & Pharmaceutical Bulletin

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“…We build on prior work, where symptoms, functional limitations, and medication burden were increased individually among adults with advanced kidney disease. 1,3,4,20 Our study adds to the existing literature by identifying three classes of adults with advanced kidney disease, and importantly, one particular high-burden class with significant pain and psychological symptoms, difficulties with ADLs and IADLs, and polypharmacy. This high-burden Complex Needs class also had increased cognitive impairment, higher financial stress, and lower social support compared with the other classes.…”

Section: Discussionmentioning

confidence: 91%

Phenotypes of Symptom, Function, and Medication Burden in Older Adults with Nondialysis Advanced Kidney Disease

Ma,

Berkowitz,

Olsen

et al. 2023

Kidney360

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Background: Older adults with advanced chronic kidney disease (CKD, stages 4 and 5) have significant symptoms, polypharmacy, and functional difficulties and prior studies evaluated these burdens separately. Identifying subgroups with similar patterns of burdens could help clinicians optimize care for these individuals. Methods: We conducted a secondary analysis of 377 older participants (≥ 70 years old) with stage 4 and 5 CKD at high risk of hospitalization enrolled in a national Veterans Affairs (VA) prospective cohort study. Adults on dialysis or with prior kidney transplant were excluded. We used latent class analysis (LCA) to identify participants with similar patterns across symptoms, medication burden, and function. Sixteen variables were included: symptoms (anxiety, depression, appetite, pain, shortness of breath, fatigue, dizziness, leg weakness, constipation, stiffness using the Symptom Burden Score), polypharmacy (≥ 10 medications and potentially inappropriate medications), and function (activities of daily living (ADL), physical and cognitive instrumental activities of daily living (IADLs), falls in the last year). We also compared 12 month hospitalization and mortality between the three classes. Results: Three classes of participants with similar functional impairment, medication burden, and symptom phenotypes were identified. The largest participant class (N=208) primarily had difficulties with physical IADLs and polypharmacy. The second participant class (N=99) had shortness of breath, constipation, and dizziness. The third participant class (N=70) had complex needs with daily pain, psychological symptoms (anxiety and depression), functional limitations (ADLs and physical and cognitive IADLs), and polypharmacy. The three classes had significantly different levels of comorbidities, financial stress, and social support. There were no significant differences in mortality and hospitalization among the three classes. Conclusion: There are distinct classes of older adults with advanced CKD who have physical and psychological symptoms, functional impairment, and medication burden. Tailoring care for this population should include a multidisciplinary team to address these overlapping symptoms, medication, and functional needs.

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“…Since the Vektis database lacks detailed clinical information, we used proxies to assess the prevalence of chronic conditions in our study population. The variables diabetes mellitus, macrovascular disease [including coronary artery disease, peripheral artery disease and cerebrovascular accident (CVA)/transient ischemic attack (TIA)], and malignancies were based on combinations of DBC codes, primary care codes and medication use [ 15 ]. The variables chronic obstructive pulmonary disease (COPD) and Parkinson's were based on medication profiles, i.e.…”

Section: Methodsmentioning

confidence: 99%

Chronic prescription of antidepressant medication in patients with chronic kidney disease with and without kidney replacement therapy compared with matched controls in the Dutch general population

Oosten

Koning

Logtenberg

et al. 2021

Clinical Kidney Journal

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Background Chronic kidney disease (CKD) is associated with a higher prevalence of depression, neuropathic pain, and insomnia. These conditions are often treated pharmaceutically. In this study, we aimed to determine the prevalence of chronic antidepressant use among CKD patients with and without kidney replacement therapy (KRT). Method By using the Dutch health claims database, we were able to determine the prevalence, type and dosage of chronic antidepressant prescription in patients with CKD stage G4/G5 without KRT (n = 14905), patients on dialysis (n = 3872), and patients living on a functioning graft (n = 8796) and compared these to age, sex, and socioeconomic status (SES)-matched controls from the general population. Results Our data show that the prevalence of chronic antidepressant prescription is 5.6%, 5.3%, and 4.2% in CKD stage G4/G5, dialysis, and kidney transplant patients, respectively, which is significantly higher than in matched controls. Although our data revealed higher prescription in female patients and in the age category 45–64 years, our data did not show any association between antidepressant prescription and SES. Selective serotonin reuptake inhibitors (SSRI) were the most prescribed drugs in all patient groups and controls. Tricyclic antidepressants (TCA) were more often used in patients compared to controls. Conclusion This nation-wide analysis revealed that chronic antidepressant prescription in the Netherlands is higher in CKD patients with and without KRT than in controls, higher in middle aged patients and women, unrelated to socioeconomic status, and lower than chronic use reported in other countries.

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

Cited by 23 publications

References 46 publications

Anorexia Assessed by Simplified Nutritional Appetite Questionnaire and Association with Medication in Older Patients Undergoing Hemodialysis

Anorexia Assessed by Simplified Nutritional Appetite Questionnaire and Association with Medication in Older Patients Undergoing Hemodialysis

Phenotypes of Symptom, Function, and Medication Burden in Older Adults with Nondialysis Advanced Kidney Disease

Chronic prescription of antidepressant medication in patients with chronic kidney disease with and without kidney replacement therapy compared with matched controls in the Dutch general population

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