Prescription characteristics of phosphate binders in a high pill burden for hemodialysis patients

Abstract

Background Dialysis patients have to take many oral drugs, causing a high pill burden. Phosphate binders (PBs) account for a large proportion of daily pill burden; however, the relationship between patient background and prescription status of PBs is not clear. Methods We clarified the characteristics of PBs in the total daily pill burden by analyzing the drugs prescribed for 533 chronic hemodialysis patients in our facility. Results An average of nine different types of oral drugs was prescribed for each patient. The mean and median values of total pill burden were 15.1 and 14.1 pills/day/patient, respectively. The total pill burden showed a significant negative correlation with age and a significant positive correlation with dialysis vintage. In addition, the total pill burden was significantly higher in males than in females. However, there was no difference in the pill burden between patients with and without diabetes mellitus (DM). PBs were prescribed to 409 patients (76.7%), and the mean pill burden derived from PBs was 6.44 pills/day/patient. This was by far the highest of all 35 different drug categories and accounted for 32.84% of all pills. Multiple regression analysis demonstrated that independent predictors of total pill burden were age, dialysis vintage, DM, and serum phosphorus (P) levels, and all these variables, except DM, were also independent predictors of pill burden from PBs. These variables were also selected when considering the use of calcimimetics. Conclusions A high pill burden is more likely to occur in younger patients with longer dialysis vintage, DM, higher serum P levels, and prescription of calcimimetics. In addition, PB was the single largest contributor to the total pill burden that positively and linearly linked to serum P levels. Therefore, P management is a high-priority issue in the mitigation of high pill burdens in dialysis patients.

Impact of phosphate binders on medication dosing frequency, timing, and number of prescribed pills in hemodialysis patients

“…This study is a post‐hoc analysis of a previously reported single‐center cross‐sectional study [10]. Of the 546 chronic hemodialysis patients at our dialysis center in the Heisei Hidaka clinic (Gunma, Japan), we excluded 13 patients who were not on stable hemodialysis during the study period (February 2020).…”

“…The patient background, dialysis condition, serum chemistries, and comorbidities in 533 patients were described in detail in a previous report [10]. The median value of the total daily pill burden was 14.1 (10.0–18.7) pills/day/patient.…”

Impact of phosphate binders on quality of life in dialysis patients: Results from the prospective Dutch nOcturnal and hoME dialysis Study To Improve Clinical Outcomes study

“…They are prescribed on average 9-12 types of medications and have a daily pill burden of 15-19 pills. [1][2][3] A recent study found that a larger number of medications is associated with a lower health-related quality of life (HRQoL) and a higher number of symptoms in dialysis patients. 3 The group of medications contributing most to dialysis patients' pill burden are phosphate binders which comprise 30%-50% of their pill burden.…”

“…3 The group of medications contributing most to dialysis patients' pill burden are phosphate binders which comprise 30%-50% of their pill burden. 1,2 These drugs are typically prescribed to manage hyperphosphatemia, one of the typical sequelae of chronic kidney disease and an important risk factor for cardiovascular disease and mortality. 4,5 Besides their high pill burden, phosphate binders, complicate medication regimens.…”

“…Dialysis patients are prescribed many medications to improve metabolic control and manage comorbidities. They are prescribed on average 9–12 types of medications and have a daily pill burden of 15–19 pills 1–3 . A recent study found that a larger number of medications is associated with a lower health‐related quality of life (HRQoL) and a higher number of symptoms in dialysis patients 3 …”