Abstract
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. 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. 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]. 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.
Highlights
Polypharmacy rates are rising, amongst older people.[1]
Polypharmacy and inappropriate prescribing are common in people with all stages of chronic kidney disease (CKD), including those receiving renal replacement therapy (RRT).[11,12,13,14,15,16]
The prevalence of polypharmacy is over three-times higher than that observed in people of a similar age in the general population in England (28% in patients aged 60 years or above), but consistent with that reported in the French CKD-REIN cohort (87% for patients with CKD stage 4 or 5).[2,12]
Summary
Polypharmacy rates are rising, amongst older people.[1]. Drivers for polypharmacy in the general population include multimorbidity, increased use of preventative medications, and guidelines which focus on single diseases.[2,3,4,5] Negative consequences of polypharmacy include drugdrug interactions, adverse drug reactions, poor adherence and increased treatment burden, alongside greater medication costs.[6,7,8,9,10]Polypharmacy and inappropriate prescribing are common in people with all stages of chronic kidney disease (CKD), including those receiving renal replacement therapy (RRT).[11,12,13,14,15,16] For people with advanced CKD, two key factors which influence prescribing are the high levels of comorbidity and the development and treatment of CKD related complications; for example, renal anaemia and renal bone disease.[11,17] patients with advanced CKD are vulnerable to adverse drug events due to altered pharmacodynamics and pharmacokinetics. People with chronic kidney disease (CKD) are at high-risk of polypharmacy. This paper aims to examine prescribing and polypharmacy patterns amongst older people with advanced CKD across the countries involved in the European Quality Study (EQUAL). Polypharmacy was defined ĂƐшρŵĞĚŝĐĂƚŝŽŶƐĂŶĚŚLJƉĞƌƉŽůLJƉŚĂƌŵĂĐLJĂƐшϭϬ Univariable and multivariable linear regression were used to determine associations between country and number of prescribed medications. Univariable and multivariable logistic regression were used to determine associations between country and hyperpolypharmacy. There were international differences in prescribing with significantly greater hyperpolypharmacy in Germany (OR 2.75, 95% CI 1.73-4.37, p
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