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

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

doi:10.1093/ckj/sfab120

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

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

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

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Abstract

Background. This study aims to examine polypharmacy (PP) prevalence in patients with chronic kidney disease (CKD) Stage G4/G5 and patients with kidney replacement therapy (KRT) compared with matched controls from the general population. Furthermore, we examine risk factors for PP and describe the most commonly dispensed medications.

Methods. Dutch health claims data were used to identify three patient groups: CKD Stage G4/G5, dialysis and kidney transplant patients. Each patient was matched to two controls based on age, sex and socio-economic status (SES) score. We differentiated between 'all medication use' and 'chronic medication use'. PP was defined at three levels: use of >= 5 medications (PP), >= 10 medications [excessive PP (EPP)] and >= 15 medications [hyper PP (HPP)].

Results. The PP prevalence for all medication use was 87, 93 and 95% in CKD Stage G4/G5, dialysis and kidney transplant patients, respectively. For chronic medication use, this was 66, 70 and 75%, respectively. PP and comorbidity prevalence were higher in patients than in controls. EPP was 42 times more common in young CKD Stage G4/G5 patients (ages 20-44years) than in controls, while this ratio was 3.8 in patients >= 75years. Older age (64-75 and >= 75years) was a risk factor for PP in CKD Stage G4/G5 and kidney transplant patients. Dialysis patients >= 75years of age had a lower risk of PP compared with their younger counterparts. Additional risk factors in all patients were low SES, diabetes mellitus, vascular disease, hospitalization and an emergency room visit. The most commonly dispensed medications were proton pump inhibitors (PPIs) and statins.

[GRAPHICS]

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Conclusions. CKD Stage G4/G5 patients and patients on KRT have a high medication burden, far beyond that of individuals from the general population, as a result of their kidney disease and a large burden of comorbidities. A critical approach to medication prescription in general, and of specific medications like PPIs and statins (in the dialysis population), could be a first step towards more appropriate medication use.

Original language	English
Pages (from-to)	2497-2523
Number of pages	27
Journal	Clinical Kidney Journal
Volume	14
Issue number	12
DOIs	https://doi.org/10.1093/ckj/sfab120
Publication status	Published - Dec-2021

Keywords

CKD
dialysis
health claims data
kidney transplantation
medication use
polypharmacy
AMBULATORY HEMODIALYSIS-PATIENTS
PILL BURDEN
OLDER-ADULTS
EPIDEMIOLOGY
MANAGEMENT
COST

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@article{730953ca12364e4e846be5a4e12de352,

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

abstract = "Background. This study aims to examine polypharmacy (PP) prevalence in patients with chronic kidney disease (CKD) Stage G4/G5 and patients with kidney replacement therapy (KRT) compared with matched controls from the general population. Furthermore, we examine risk factors for PP and describe the most commonly dispensed medications.Methods. Dutch health claims data were used to identify three patient groups: CKD Stage G4/G5, dialysis and kidney transplant patients. Each patient was matched to two controls based on age, sex and socio-economic status (SES) score. We differentiated between 'all medication use' and 'chronic medication use'. PP was defined at three levels: use of >= 5 medications (PP), >= 10 medications [excessive PP (EPP)] and >= 15 medications [hyper PP (HPP)].Results. The PP prevalence for all medication use was 87, 93 and 95% in CKD Stage G4/G5, dialysis and kidney transplant patients, respectively. For chronic medication use, this was 66, 70 and 75%, respectively. PP and comorbidity prevalence were higher in patients than in controls. EPP was 42 times more common in young CKD Stage G4/G5 patients (ages 20-44years) than in controls, while this ratio was 3.8 in patients >= 75years. Older age (64-75 and >= 75years) was a risk factor for PP in CKD Stage G4/G5 and kidney transplant patients. Dialysis patients >= 75years of age had a lower risk of PP compared with their younger counterparts. Additional risk factors in all patients were low SES, diabetes mellitus, vascular disease, hospitalization and an emergency room visit. The most commonly dispensed medications were proton pump inhibitors (PPIs) and statins.[GRAPHICS].Conclusions. CKD Stage G4/G5 patients and patients on KRT have a high medication burden, far beyond that of individuals from the general population, as a result of their kidney disease and a large burden of comorbidities. A critical approach to medication prescription in general, and of specific medications like PPIs and statins (in the dialysis population), could be a first step towards more appropriate medication use.",

keywords = "CKD, dialysis, health claims data, kidney transplantation, medication use, polypharmacy, AMBULATORY HEMODIALYSIS-PATIENTS, PILL BURDEN, OLDER-ADULTS, EPIDEMIOLOGY, MANAGEMENT, COST",

author = "{van Oosten}, {Manon J. M.} and Logtenberg, {Susan J. J.} and Hemmelder, {Marc H.} and Leegte, {Martijn J. H.} and Bilo, {Henk J. G.} and Jager, {Kitty J.} and Stel, {Vianda S.}",

year = "2021",

month = dec,

doi = "10.1093/ckj/sfab120",

language = "English",

volume = "14",

pages = "2497--2523",

journal = "Clinical Kidney Journal",

issn = "2048-8505",

publisher = "Oxford Univ. Press, New York",

number = "12",

}

Polypharmacy and medication use in patients with chronic kidney disease with and without kidney replacement therapy compared to matched controls. / van Oosten, Manon J. M.; Logtenberg, Susan J. J.; Hemmelder, Marc H. et al.
In: Clinical Kidney Journal, Vol. 14, No. 12, 12.2021, p. 2497-2523.

Research output: Contribution to journal › Article › Academic › peer-review

TY - JOUR

T1 - Polypharmacy and medication use in patients with chronic kidney disease with and without kidney replacement therapy compared to matched controls

AU - van Oosten, Manon J. M.

AU - Logtenberg, Susan J. J.

AU - Hemmelder, Marc H.

AU - Leegte, Martijn J. H.

AU - Bilo, Henk J. G.

AU - Jager, Kitty J.

AU - Stel, Vianda S.

PY - 2021/12

Y1 - 2021/12

N2 - Background. This study aims to examine polypharmacy (PP) prevalence in patients with chronic kidney disease (CKD) Stage G4/G5 and patients with kidney replacement therapy (KRT) compared with matched controls from the general population. Furthermore, we examine risk factors for PP and describe the most commonly dispensed medications.Methods. Dutch health claims data were used to identify three patient groups: CKD Stage G4/G5, dialysis and kidney transplant patients. Each patient was matched to two controls based on age, sex and socio-economic status (SES) score. We differentiated between 'all medication use' and 'chronic medication use'. PP was defined at three levels: use of >= 5 medications (PP), >= 10 medications [excessive PP (EPP)] and >= 15 medications [hyper PP (HPP)].Results. The PP prevalence for all medication use was 87, 93 and 95% in CKD Stage G4/G5, dialysis and kidney transplant patients, respectively. For chronic medication use, this was 66, 70 and 75%, respectively. PP and comorbidity prevalence were higher in patients than in controls. EPP was 42 times more common in young CKD Stage G4/G5 patients (ages 20-44years) than in controls, while this ratio was 3.8 in patients >= 75years. Older age (64-75 and >= 75years) was a risk factor for PP in CKD Stage G4/G5 and kidney transplant patients. Dialysis patients >= 75years of age had a lower risk of PP compared with their younger counterparts. Additional risk factors in all patients were low SES, diabetes mellitus, vascular disease, hospitalization and an emergency room visit. The most commonly dispensed medications were proton pump inhibitors (PPIs) and statins.[GRAPHICS].Conclusions. CKD Stage G4/G5 patients and patients on KRT have a high medication burden, far beyond that of individuals from the general population, as a result of their kidney disease and a large burden of comorbidities. A critical approach to medication prescription in general, and of specific medications like PPIs and statins (in the dialysis population), could be a first step towards more appropriate medication use.

AB - Background. This study aims to examine polypharmacy (PP) prevalence in patients with chronic kidney disease (CKD) Stage G4/G5 and patients with kidney replacement therapy (KRT) compared with matched controls from the general population. Furthermore, we examine risk factors for PP and describe the most commonly dispensed medications.Methods. Dutch health claims data were used to identify three patient groups: CKD Stage G4/G5, dialysis and kidney transplant patients. Each patient was matched to two controls based on age, sex and socio-economic status (SES) score. We differentiated between 'all medication use' and 'chronic medication use'. PP was defined at three levels: use of >= 5 medications (PP), >= 10 medications [excessive PP (EPP)] and >= 15 medications [hyper PP (HPP)].Results. The PP prevalence for all medication use was 87, 93 and 95% in CKD Stage G4/G5, dialysis and kidney transplant patients, respectively. For chronic medication use, this was 66, 70 and 75%, respectively. PP and comorbidity prevalence were higher in patients than in controls. EPP was 42 times more common in young CKD Stage G4/G5 patients (ages 20-44years) than in controls, while this ratio was 3.8 in patients >= 75years. Older age (64-75 and >= 75years) was a risk factor for PP in CKD Stage G4/G5 and kidney transplant patients. Dialysis patients >= 75years of age had a lower risk of PP compared with their younger counterparts. Additional risk factors in all patients were low SES, diabetes mellitus, vascular disease, hospitalization and an emergency room visit. The most commonly dispensed medications were proton pump inhibitors (PPIs) and statins.[GRAPHICS].Conclusions. CKD Stage G4/G5 patients and patients on KRT have a high medication burden, far beyond that of individuals from the general population, as a result of their kidney disease and a large burden of comorbidities. A critical approach to medication prescription in general, and of specific medications like PPIs and statins (in the dialysis population), could be a first step towards more appropriate medication use.

KW - CKD

KW - dialysis

KW - health claims data

KW - kidney transplantation

KW - medication use

KW - polypharmacy

KW - AMBULATORY HEMODIALYSIS-PATIENTS

KW - PILL BURDEN

KW - OLDER-ADULTS

KW - EPIDEMIOLOGY

KW - MANAGEMENT

KW - COST

U2 - 10.1093/ckj/sfab120

DO - 10.1093/ckj/sfab120

M3 - Article

SN - 2048-8505

VL - 14

SP - 2497

EP - 2523

JO - Clinical Kidney Journal

JF - Clinical Kidney Journal

IS - 12

ER -

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

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