Prevalence of polypharmacy and associated adverse health outcomes in adult patients with chronic kidney disease: protocol for a systematic review and meta-analysis

Abstract

Background Polypharmacy, often defined as the concomitant use of ≥ 5 medications, has been identified as a significant global public health threat. Aging and multimorbidity are key drivers of polypharmacy and have been linked to a broad range of adverse health outcomes and mortality. Patients with chronic kidney disease (CKD) are particularly at high risk of polypharmacy and use of potentially inappropriate medications given the numerous risk factors and complications associated with CKD. The aim of this systematic review will be to assess the prevalence of polypharmacy among adult patients with CKD, and the potential association between polypharmacy and adverse health outcomes within this population. Methods/design We will search empirical databases such as MEDLINE, Embase, Cochrane Library, CINAHL, Web of Science, and PsycINFO and grey literature from inception onwards (with no language restrictions) for observational studies (e.g., cross-sectional or cohort studies) reporting the prevalence of polypharmacy in adult patients with CKD (all stages including dialysis). Two reviewers will independently screen all citations, full-text articles, and extract data. Potential conflicts will be resolved through discussion. The study methodological quality will be appraised using an appropriate tool. The primary outcome will be the prevalence of polypharmacy. Secondary outcomes will include any adverse health outcomes (e.g., worsening kidney function) in association with polypharmacy. If appropriate, we will conduct random effects meta-analysis of observational data to summarize the pooled prevalence of polypharmacy and the associations between polypharmacy and adverse outcomes. Statistical heterogeneity will be estimated using Cochran’s Q and I2 index. Additional analyses will be conducted to explore the potential sources of heterogeneity (e.g., sex, kidney replacement therapy, multimorbidity). Discussion Given that polypharmacy is a major and a growing public health issue, our findings will highlight the prevalence of polypharmacy, hazards associated with it, and medication thresholds associated with adverse outcomes in patients with CKD. Our study will also draw attention to the prognostic importance of improving medication practices as a key priority area to help minimize the use of inappropriate medications in patients with CKD. Systematic review registration PROSPERO registration number: [CRD42020206514].

Factors related to polypharmacy and hyper‐polypharmacy for the elderly: A nationwide cohort study using National Health Insurance data in South Korea

“…[5][6][7][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38] In particular, several systematic reviews reported that polypharmacy and excessive polypharmacy (the use of 10 or more medications) was associated with adverse outcomes, such as allcause mortality, frailty, hospitalization, and 3-month read mission. 5,7,8,26,30,31,34,[39][40][41][42][43][44][45] Therefore, there is an increasing need to manage polypharmacy in patients with multiple conditions, both in Korea and around the world. [46][47][48] To our knowledge, this is the first study to examine the determinants of polypharmacy among outpatient prescription drugs in an overall population-based study of more than 7.36 million individuals including the entire elderly population of South Korea.…”

“…According to several studies, including clinical trials, observational studies, and systematic reviews, polypharmacy and hyper‐polypharmacy in the elderly have been found to show negative effects on their health 5–7,22–38 . In particular, several systematic reviews reported that polypharmacy and excessive polypharmacy (the use of 10 or more medications) was associated with adverse outcomes, such as all‐cause mortality, frailty, hospitalization, and 3‐month readmission 5,7,8,26,30,31,34,39–45 . Therefore, there is an increasing need to manage polypharmacy in patients with multiple conditions, both in Korea and around the world 46–48 …”

“… 5 , 6 , 7 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 In particular, several systematic reviews reported that polypharmacy and excessive polypharmacy (the use of 10 or more medications) was associated with adverse outcomes, such as all‐cause mortality, frailty, hospitalization, and 3‐month readmission. 5 , 7 , 8 , 26 , 30 , 31 , 34 , 39 , 40 , 41 , 42 , 43 , 44 , 45 Therefore, there is an increasing need to manage polypharmacy in patients with multiple conditions, both in Korea and around the world. 46 , 47 , 48 …”

A focus on CKD reporting and inappropriate prescribing among older patients discharged from geriatric and nephrology units throughout Italy: A nationwide multicenter retrospective cross-sectional study

“…Indeed, several medications, including antidiabetics, beta-blockers, nonsteroidal anti-inflammatory drugs (NSAIDs), and renin-angiotensin-aldosterone system (RAAS) inhibitors, have shown nephrotoxic potential (Okoro and Farate, 2019). In this regard, in 2017, the World Health Organization (WHO) highlighted the need to address unsafe medication regimens and errors, which are often associated with an increased individual risk/benefit ratio (Okpechi et al, 2021). Adherence to validated criteria of appropriate prescriptions, such as the screening tool to alert to right treatment/screening tool of older people's prescriptions (START/STOPP) (O'Mahony, 2020); and American Geriatric Society (AGS) Beers criteria (by the 2019 American Geriatrics Society Beers Criteria ® Update Expert Panel, 2019), may serve as a starting point to revise pharmacological regimens, especially during hospital stay; however, the silent course of CKD may delay the diagnosis of the disease and provision of appropriate treatment options to avoid polypharmacy burden (Fiseha et al, 2014;Carriazo et al, 2021).…”

The Role of Medication Literacy and Polypharmacy in Sarcopenia Among Maintenance Hemodialysis Patients: A Cross-Sectional Analysis

“…This nding highlights the compound challenge posed by complex medication regimens and insu cient medication knowledge, which may contribute to suboptimal management of sarcopenia in this vulnerable group [29]. Who might be at a higher risk of adverse outcomes due to the combined effect of polypharmacy and limited medication literacy [30][31][32][33].…”