Medication Prescription, Common Side-effects, and Nutritional Status are Associated in Patients With Chronic Kidney Disease

Helene Dahl,Silje R.T Sandblost,Natasha L Welland,Kristina Sandnes,Ingegjerd Sekse,Kristin Sæle,Hans-Peter Marti,Lone Holst,Jutta Dierkes

doi:10.1053/j.jrn.2021.10.008

Helene Dahl, Silje R.T Sandblost + Show 7 more

Open Access

https://doi.org/10.1053/j.jrn.2021.10.008

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Abstract

Chronic kidney disease (CKD) is associated with metabolic, nutritional, and extra-renal changes, as well as a high rate of comorbidities, which necessitates the prescription of numerous medications. Patients with CKD often experience poor nutritional status related to disease severity and prescribed medication; however, this association has not been investigated in depth. Therefore, this study aimed at investigating the association between prescribed medication and nutritional status in patients with CKD. Assessment of nutritional status was performed using anthropometric and functional measurements and by biochemical measures. Patient history and the number and type of currently prescribed medications were collected from patients' records. We evaluated the total number and the number of specific medicines with common or very common side-effects of nausea or xerostomia. Two hundred seventeen patients with CKD were included in this cross-sectional study (n=112 with pre-dialysis CKD stages 3-5, n=33 with hemodialysis, and n=72 with kidney transplant). On average, patients were prescribed nine medications concurrently. The number of prescribed medications was inversely associated with mid-upper arm circumference, skinfold thickness triceps, handgrip strength, serum albumin, and hemoglobin after adjustment for age, sex, and kidney function. Prescription of medications with nausea as a side-effect showed similar associations, whereas prescription of medications with xerostomia as a side-effect was associated with lower handgrip strength. Medication prescription was associated with poor nutritional status in patients with CKD, and monitoring of nutritional status in patients with CKD with long medication lists is warranted to identify and treat patients with poor nutritional status.

Highlights

DISEASE PROGRESSION IN chronic kidney disease (CKD) is associated with major metabolic, nutritional, and extra-renal changes, all associated with increased use of pharmacotherapy
A total of 217 patients with CKD were included in this study; of those, 112 patients were with predialysis CKD stages 3-5, 33 patients were with endstage kidney disease (ESKD) receiving hemodialysis, and 72 patients were kidney transplanted patients
When nutritional status was described with additional measures (MUAC, SFT triceps, handgrip strength (HGS), albumin, and hemoglobin), we observed an association between an increased number of prescribed medications and poorer outcomes of these measures

Summary

Introduction

DISEASE PROGRESSION IN chronic kidney disease (CKD) is associated with major metabolic, nutritional, and extra-renal changes, all associated with increased use of pharmacotherapy. As the kidney function declines, dietary intake and metabolism of nutrients will be affected, increasing the occurrence and severity of poor nutritional status.[3,4]. These may include both obesity and undernutrition, as well as changes in nutrient metabolism.[5,6] a thorough assessment of nutritional status is required, including anthropometric measurements, functional tests, and biomarkers such as albumin and hemoglobin.[7,8,9].

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