Risk of Kidney Dysfunction from Polypharmacy among Older Patients: A Nested Case-Control Study of the South Korean Senior Cohort

Abstract

Polypharmacy, the concurrent use of multiple medicines, could increase the risk of kidney dysfunction among older adults because it likely burdens the aging kidneys to excrete multiple pharmaceutical ingredients and their metabolites. This study aimed to examine the relation between polypharmacy and kidney dysfunction among older patients. A nested case-control study was conducted using the National Health Insurance Service – Senior Cohort (NHIS-SC, 2009–2013), representative of the Korean senior population. It consisted of all health insurance claims linked to records of mandatory health examination. Kidney dysfunction was defined as having an eGFR lower than 60, with a decline rate of 10% or more compared to the baseline eGFR. Polypharmacy was defined based on daily counts of pharmaceutical ingredients during one year prior to the case’s event date. It was classified into polypharmacy (five to 10 ingredients) and excessive polypharmacy (10 or more ingredients). After matching case and control groups based on a range of potential confounders, conditional logistic regression was performed incorporating adjustments on disease-specific, medication-specific, and lifestyle-related risk factors. The matching resulted in 14,577 pairs of cases and controls. Exposure to polypharmacy was significantly associated with increase in the risk of kidney dysfunction; i.e., crude model (polypharmacy: OR = 1.572, 95% CI = 1.492–1.656; excessive polypharmacy: OR = 2.069, 95% CI = 1.876–2.283) and risk adjustment model (polypharmacy: OR = 1.213, 95% CI = 1.139–1.292; excessive polypharmacy: OR = 1.461, 95% CI = 1.303–1.639). The significant associations were robust across different definitions of kidney dysfunction. These findings inform healthcare providers and policy makers of the importance of polypharmacy prevention to protect older adults from kidney dysfunction.

Onset of Hyperkalemia following the Administration of Angiotensin-Converting Enzyme Inhibitor or Angiotensin II Receptor Blocker

“…Hyperkalemia occurs most readily when there is renal dysfunction because kidneys play an important role in potassium homeostasis, where 90% of the excess potassium is excreted specifically through the kidneys [16]. The results of this study adhere to the above theory, since, according to our observations, the factors associated with abnormal renal function [17], among the various possible factors, showed the most significant impact on the development of ACEIor ARB-induced hyperkalemia [18]. That is, the incidence of hyperkalemia was higher in the presence of higher creatinine, lower MDRD-eGFR, and comorbid renal failure.…”

Influencing factors and their relationships of risk perception and decision-making behaviour of polypharmacy in patients with chronic diseases: a qualitative descriptive study

“…42 The concurrent use of multiple medications increased the risk of kidney dysfunction among older adults because it could burden the ageing kidneys to excrete multiple pharmaceutical ingredients and their metabolites. 43 The results of other relevant studies on the impact of polypharmacy on kidney function also indicated that every additional drug prescribed among older adults will have an independent and immediate harmful impact on their kidney function. 44 These findings suggest that some patients with chronic diseases did not have enough knowledge about drug use.…”

Polypharmacy and the Progression of Chronic Kidney Disease: Korean Cohort Study for Outcome in Patients with Chronic Kidney Disease

“…However, not only the elderly are at risk; adults with chronic diseases, such as cancer [33], chronic obstructive pulmonary disease [34], and diabetes [35] are in danger as a result of polypharmacy; patients with CKD, a disease commonly associated with the premature aging [36], are at particular risk [17-19]. Although polypharmacy has a significant potential to deteriorate kidney function [22, 37], there have been no studies that explore the hazard of polypharmacy on the progression of CKD in the CKD population. In this large-scaled prospective predialysis CKD cohort, however, we could not confirm the direct effect of multiple medications on the CKD progression.…”