Hiroshi Kimura1, Kenichi Tanaka2,3, Hirotaka Saito2, Tsuyoshi Iwasaki2, Akira Oda2, Shuhei Watanabe2, Makoto Kanno2,3, Michio Shimabukuro3,4, Koichi Asahi3,5, Tsuyoshi Watanabe3, Junichiro James Kazama2,3. 1. Department of Nephrology and Hypertension, Fukushima Medical University, Fukushima, Japan kimuhiro@fmu.ac.jp. 2. Department of Nephrology and Hypertension, Fukushima Medical University, Fukushima, Japan. 3. Division of Advanced Community Based Care for Lifestyle Related Diseases, Fukushima Medical University, Fukushima, Japan. 4. Department of Diabetes, Endocrinology and Metabolism, Fukushima Medical University, Fukushima, Japan. 5. Division of Nephrology and Hypertension, Iwate Medical University, Yahaba, Japan.
Abstract
BACKGROUND AND OBJECTIVE: Polypharmacy is common in patients with CKD and reportedly associated with adverse outcomes. However, its effect on kidney outcomes among patients with CKD has not been adequately elucidated. Hence, this investigation was aimed at exploring the association between polypharmacy and kidney failure requiring KRT. DESIGN, SETTING, PARTICIPANTS, AND MEASUREMENTS: We retrospectively examined 1117 participants (median age, 66 years; 56% male; median eGFR, 48 ml/min per 1.73 m2) enrolled in the Fukushima CKD Cohort Study to investigate the association between the number of prescribed medications and adverse outcomes such as kidney failure, all-cause mortality, and cardiovascular events in Japanese patients with nondialysis-dependent CKD. Polypharmacy and hyperpolypharmacy were defined as the regular use of 5-9 and ≥10 medications per day, respectively. RESULTS: The median number of medications was eight; the prevalence of polypharmacy and hyperpolypharmacy was each 38%. During the observation period (median, 4.8 years), 120 developed kidney failure, 153 developed cardiovascular events, and 109 died. Compared with the use of fewer than five medications, adjusted hazard ratios (95% confidence intervals) associated with polypharmacy and hyperpolypharmacy were 2.28 (1.00 to 5.21) and 2.83 (1.21 to 6.66) for kidney failure, 1.60 (0.85 to 3.04) and 3.02 (1.59 to 5.74) for cardiovascular events, and 1.25 (0.62 to 2.53) and 2.80 (1.41 to 5.54) for all-cause mortality. CONCLUSIONS: The use of a high number of medications was associated with a high risk of kidney failure, cardiovascular events, and all-cause mortality in Japanese patients with nondialysis-dependent CKD under nephrology care.
BACKGROUND AND OBJECTIVE: Polypharmacy is common in patients with CKD and reportedly associated with adverse outcomes. However, its effect on kidney outcomes among patients with CKD has not been adequately elucidated. Hence, this investigation was aimed at exploring the association between polypharmacy and kidney failure requiring KRT. DESIGN, SETTING, PARTICIPANTS, AND MEASUREMENTS: We retrospectively examined 1117 participants (median age, 66 years; 56% male; median eGFR, 48 ml/min per 1.73 m2) enrolled in the Fukushima CKD Cohort Study to investigate the association between the number of prescribed medications and adverse outcomes such as kidney failure, all-cause mortality, and cardiovascular events in Japanese patients with nondialysis-dependent CKD. Polypharmacy and hyperpolypharmacy were defined as the regular use of 5-9 and ≥10 medications per day, respectively. RESULTS: The median number of medications was eight; the prevalence of polypharmacy and hyperpolypharmacy was each 38%. During the observation period (median, 4.8 years), 120 developed kidney failure, 153 developed cardiovascular events, and 109 died. Compared with the use of fewer than five medications, adjusted hazard ratios (95% confidence intervals) associated with polypharmacy and hyperpolypharmacy were 2.28 (1.00 to 5.21) and 2.83 (1.21 to 6.66) for kidney failure, 1.60 (0.85 to 3.04) and 3.02 (1.59 to 5.74) for cardiovascular events, and 1.25 (0.62 to 2.53) and 2.80 (1.41 to 5.54) for all-cause mortality. CONCLUSIONS: The use of a high number of medications was associated with a high risk of kidney failure, cardiovascular events, and all-cause mortality in Japanese patients with nondialysis-dependent CKD under nephrology care.
Authors: Solène M Laville; Marie Metzger; Bénédicte Stengel; Christian Jacquelinet; Christian Combe; Denis Fouque; Maurice Laville; Luc Frimat; Carole Ayav; Elodie Speyer; Bruce M Robinson; Ziad A Massy; Sophie Liabeuf Journal: Br J Clin Pharmacol Date: 2018-09-24 Impact factor: 4.335
Authors: Simon D S Fraser; Paul J Roderick; Carl R May; Natasha McIntyre; Christopher McIntyre; Richard J Fluck; Adam Shardlow; Maarten W Taal Journal: BMC Nephrol Date: 2015-12-01 Impact factor: 2.388