Polypharmacy and the Progression of Chronic Kidney Disease: Korean Cohort Study for Outcome in Patients with Chronic Kidney Disease
Open Access
- 1 August 2021
- journal article
- research article
- Published by S. Karger AG in Kidney and Blood Pressure Research
- Vol. 46 (4), 460-468
- https://doi.org/10.1159/000516029
Abstract
Introduction: The renal hazard of polypharmacy has never been evaluated in predialysis chronic kidney disease (CKD) patients. Objective: We aimed to analyze the renal hazard of polypharmacy in predialysis CKD patients with stage 1-5. Method: The data of 2,238 patients from a large-scale multicenter prospective Korean study (2011-2016), excluding 325 patients with various missing data, were reviewed. Polypharmacy was defined as taking 6 or more medications at the time of enrollment; renal events were defined as a >= 50% decrease in kidney function from baseline values, doubling of the serum creatinine levels, or initiation of renal replacement treatment. Hazard ratio (HR) and 95% confidence interval (CI) were calculated using Cox proportional-hazard regression analysis. Results: Of the 1,913 patients, the mean estimated glomerular filtration rate was 53.6 mL/min/1.73 m(2). The mean medication count was 4.1, and the prevalence of polypharmacy was 27.1%. During the average period of 3.6 years, 520 patients developed renal events (27.2%). Although increased medication counts were associated with increased renal hazard with HR (95% CI) of 1.056 (1.007-1.107, p = 0.025), even after adjusting for various confounders, adding comorbidity score and kidney function nullified the statistical significance. In mediation analysis, 55.6% (p = 0.016) of renal hazard in increased medication counts was mediated by the kidney function, and there was no direct effect of medication counts on renal event development. In subgroup analysis, the renal hazard of the medication counts was evident only in stage 1-3 of CKD patients (p for interaction = 0.014). Conclusions: We cannot identify the direct renal hazard of multiple medications, and most of the potential renal hazard was derived from intimate relationship with disease burden and kidney function.This publication has 39 references indexed in Scilit:
- Temporal Trends in Polypharmacy and Hyperpolypharmacy in Older New Zealanders over a 9-Year Period: 2005-2013Gerontology, 2014
- Disease burden and risk profile in referred patients with moderate chronic kidney disease: composition of the German Chronic Kidney Disease (GCKD) cohortNephrology Dialysis Transplantation, 2014
- Physical performance measures and polypharmacy among hospitalized older adults: Results from the crime studyThe journal of nutrition, health & aging, 2014
- KNOW-CKD (KoreaN cohort study for Outcome in patients With Chronic Kidney Disease): design and methodsBMC Nephrology, 2014
- Evaluation and Management of Chronic Kidney Disease: Synopsis of the Kidney Disease: Improving Global Outcomes 2012 Clinical Practice GuidelineAnnals of Internal Medicine, 2013
- Association between clusters of diseases and polypharmacy in hospitalized elderly patients: Results from the REPOSI studyEuropean Journal of Internal Medicine, 2011
- Polypharmacy Correlates With Increased Risk for Hip Fracture in the ElderlyMedicine, 2010
- Prevalence and predictors of polypharmacy among older primary care patients in GermanyFamily Practice, 2006
- Effectiveness of telephone counselling by a pharmacist in reducing mortality in patients receiving polypharmacy: randomised controlled trialBMJ, 2006
- Validation of a combined comorbidity indexJournal of Clinical Epidemiology, 1994