Prevalence and global trends of polypharmacy in patients with chronic kidney disease: A systematic review and meta-analysis

Abstract

Background and objectives: Polypharmacy and chronic kidney disease (CKD) are becoming increasingly common due to an ageing population and the rise of multimorbidity. In line with the therapeutic guidelines, managing CKD and its complications necessitates prescribing multiple medications, which predisposes patients to polypharmacy. The aim of this systematic review and meta-analysis is to describe the prevalence of polypharmacy in patients with CKD and to explore the global trends of factors driving any apparent variability in prevalence estimates.Methods: PubMed, Scopus, the Cochrane Database of Systematic Reviews (CDSR), and Google Scholar were searched from 1999 to November 2021. Study selection, data extraction, and critical appraisal were conducted by two independent reviewers. The pooled prevalence of polypharmacy was estimated utilizing the random effects model using the default double arcsine transformation.Results: This review involved 14 studies comprising of 17 201 participants, a significant proportion of which were males (56.12%). The mean age of the review population was 61.96 (SD ± 11.51) years. The overall pooled prevalence of polypharmacy amongst patients with CKD was 69% (95% CI: 49%–86%) (I2 = 100%, p < 0.0001), with a proportionately higher prevalence in North America and Europe as compared to Asia.Conclusion: The results from this meta-analysis showed a high pooled prevalence estimates of polypharmacy amongst patient cohorts with CKD. The exact interventions that are likely to significantly mitigate its effect remain uncertain and will need exploration by future prospective and systematic studies.Systematic Review Registration: [https://www.crd.york.ac.uk/prospero/], identifier [CRD42022306572].

Polypharmacy in Patients with CKD

“…Our results corroborate findings of previous systematic reviews on polypharmacy in patients with CKD which reported a slightly lower pooled prevalence of polypharmacy 76% (95% CI, 73% to 79%) and 69% (95% CI, 49% to 86%), respectively. 16,17 Our results show the prevalence of polypharmacy in patients with CKD is substantially higher compared with the general population and patients with an increased cardiovascular risk or diabetes mellitus, who report, respectively, a polypharmacy rate of 30%-40% and 64%. [25][26][27][28] In a recent study, nephrology patients were considered to have the highest medical complexity across different medical specialties in terms of comorbidities, medication use, and health care visits.…”

“…However, both reviews focused on the prevalence of polypharmacy and did not assess other measures of medication burden such as the number of prescribed medications and pill burden nor explored the heterogeneity in polypharmacy across different subgroups of patients with CKD or the association between polypharmacy and clinical outcomes. 16 , 17 Therefore, in this systematic review, we aimed to evaluate the prevalence of polypharmacy and to evaluate the association between polypharmacy and patient-important outcomes such as all-cause mortality, CVD, and QoL. The secondary aim of this review was to evaluate the current use of FDCs in patients with CKD.…”

Commentary: Potentially inappropriate medication among older patients with diabetic kidney disease

“…These include the prevalence of polypharmacy as well as the global array of factors impacting this ( American Geriatrics Society, 2019 ). Indeed, it is out of the recognition of this significant gap in our understanding that we recently reported the first systematic examination of the clinical burden as well as socio-demographic factors that globally drive this in patients with chronic kidney disease ( Naseralallah et al, 2023 ). We found the overall pooled prevalence of polypharmacy amongst patients with CKD was 69% (95% CI: 49%–86%) (I 2 = 100%, p < 0.0001), with a proportionately higher prevalence in North America and Europe as compared to Asia ( American Geriatrics Society, 2019 ; Naseralallah et al, 2023 ; Chowdhury et al, 2017 ).…”

“…Indeed, it is out of the recognition of this significant gap in our understanding that we recently reported the first systematic examination of the clinical burden as well as socio-demographic factors that globally drive this in patients with chronic kidney disease (Naseralallah et al, 2023). We found the overall pooled prevalence of polypharmacy amongst patients with CKD was 69% (95% CI: 49%-86%) (I 2 = 100%, p < 0.0001), with a proportionately higher prevalence in North America and Europe as compared to Asia (American Geriatrics Society, 2019; Naseralallah et al, 2023;Chowdhury et al, 2017). Wang et al (2020)'s PIM estimate of 67.5% is consistent with that reported from recent studies, although those exploring larger patient populations such as Roux-Marson et al (2020), found relatively lower PIM prevalence estimates.…”

Deprescribing in Dialysis: Operationalizing “Less is More” Through a Multimodal Deprescribing Intervention

“…These efforts must incorporate contextual factors unique to people living with kidney disease, including a rapidly evolving pharmaceutical armamentarium, dosing adjustments as eGFR declines, emerging multidisciplinary kidney care models, and frequent health care engagement and associated cascading prescribing patterns. 1 , 6 , 7 …”