Samantha Hayward1,2,3, Barnaby Hole1,2,3, Rachel Denholm2, Polly Duncan2, James E Morris4, Simon D S Fraser4, Rupert A Payne2, Paul Roderick4, Nicholas C Chesnaye5, Christoph Wanner6, Christiane Drechsler6, Maurizio Postorino7, Gaetana Porto7, Maciej Szymczak8, Marie Evans9, Friedo W Dekker10, Kitty J Jager5, Fergus J Caskey2,3. 1. UK Renal Registry, Southmead Hospital, Bristol, UK. 2. Bristol Medical School, University of Bristol, Bristol, UK. 3. Department of Nephrology, Southmead Hospital, North Bristol Trust, Bristol, UK. 4. School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton UK. 5. ERA-EDTA Registry, Department of Medical Informatics, Amsterdam University Medical Center, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands. 6. Division of Nephrology, Department of Medicine, University Hospital of Würzburg, Würzburg, Germany. 7. Clinical Epidemiology and Pathophysiology of Renal Diseases and Hypertension, CNR-IFC, Reggio Calabria, Italy. 8. Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wroclaw, Poland. 9. Department of Clinical Sciences Intervention and Technology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden. 10. Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands.
Abstract
BACKGROUND: People with chronic kidney disease (CKD) are at high risk of polypharmacy. However, no previous study has investigated international prescribing patterns in this group. This article aims to examine prescribing and polypharmacy patterns among older people with advanced CKD across the countries involved in the European Quality (EQUAL) study. METHODS: The EQUAL study is an international prospective cohort study of patients ≥65 years of age with advanced CKD. Baseline demographic, clinical and medication data were analysed and reported descriptively. Polypharmacy was defined as ≥5 medications and hyperpolypharmacy as ≥10. Univariable and multivariable linear regressions were used to determine associations between country and the number of prescribed medications. Univariable and multivariable logistic regression were used to determine associations between country and hyperpolypharmacy. RESULTS: Of the 1317 participants from five European countries, 91% were experiencing polypharmacy and 43% were experiencing hyperpolypharmacy. Cardiovascular medications were the most prescribed medications (mean 3.5 per person). There were international differences in prescribing, with significantly greater hyperpolypharmacy in Germany {odds ratio (OR) 2.75 [95% confidence interval (CI) 1.73-4.37]; P < 0.001, reference group UK}, the Netherlands [OR 1.91 (95% CI 1.32-2.76); P = 0.001] and Italy [OR 1.57 (95% CI 1.15-2.15); P = 0.004]. People in Poland experienced the least hyperpolypharmacy [OR 0.39 (95% CI 0.17-0.87); P = 0.021]. CONCLUSIONS: Hyperpolypharmacy is common among older people with advanced CKD, with significant international differences in the number of medications prescribed. Practice variation may represent a lack of consensus regarding appropriate prescribing for this high-risk group for whom pharmacological treatment has great potential for harm as well as benefit.
BACKGROUND:People with chronic kidney disease (CKD) are at high risk of polypharmacy. However, no previous study has investigated international prescribing patterns in this group. This article aims to examine prescribing and polypharmacy patterns among older people with advanced CKD across the countries involved in the European Quality (EQUAL) study. METHODS: The EQUAL study is an international prospective cohort study of patients ≥65 years of age with advanced CKD. Baseline demographic, clinical and medication data were analysed and reported descriptively. Polypharmacy was defined as ≥5 medications and hyperpolypharmacy as ≥10. Univariable and multivariable linear regressions were used to determine associations between country and the number of prescribed medications. Univariable and multivariable logistic regression were used to determine associations between country and hyperpolypharmacy. RESULTS: Of the 1317 participants from five European countries, 91% were experiencing polypharmacy and 43% were experiencing hyperpolypharmacy. Cardiovascular medications were the most prescribed medications (mean 3.5 per person). There were international differences in prescribing, with significantly greater hyperpolypharmacy in Germany {odds ratio (OR) 2.75 [95% confidence interval (CI) 1.73-4.37]; P < 0.001, reference group UK}, the Netherlands [OR 1.91 (95% CI 1.32-2.76); P = 0.001] and Italy [OR 1.57 (95% CI 1.15-2.15); P = 0.004]. People in Poland experienced the least hyperpolypharmacy [OR 0.39 (95% CI 0.17-0.87); P = 0.021]. CONCLUSIONS: Hyperpolypharmacy is common among older people with advanced CKD, with significant international differences in the number of medications prescribed. Practice variation may represent a lack of consensus regarding appropriate prescribing for this high-risk group for whom pharmacological treatment has great potential for harm as well as benefit.
Authors: Justine Marienne; Solène M Laville; Pauline Caillard; Benjamin Batteux; Valérie Gras-Champel; Kamel Masmoudi; Gabriel Choukroun; Sophie Liabeuf Journal: Kidney Int Rep Date: 2020-10-17
Authors: Solène M Laville; Ziad A Massy; Said Kamel; Jean Marc Chillon; Gabriel Choukroun; Sophie Liabeuf Journal: Toxins (Basel) Date: 2021-01-26 Impact factor: 4.546
Authors: Manon J M van Oosten; Dan Koning; Susan J J Logtenberg; Martijn J H Leegte; Henk J G Bilo; Marc H Hemmelder; Kitty J Jager; Vianda S Stel Journal: Clin Kidney J Date: 2021-12-03
Authors: 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 Journal: Clin Kidney J Date: 2021-07-06