Medication-Related Factors and Hospital Readmission in Older Adults with Chronic Kidney Disease.

Wubshet H Tesfaye,Ronald L Castelino,Syed Tabish R Zaidi,Barbara C Wimmer,Gregory M Peterson,Charlotte Mckercher,Matthew Jose

doi:10.3390/jcm8030395

Abstract

This study aimed to examine the association between medication-related factors and risk of hospital readmission in older patients with chronic kidney disease (CKD). A retrospective analysis was conducted targeting older CKD (n = 204) patients admitted to an Australian hospital. Medication appropriateness (Medication Appropriateness Index; MAI), medication regimen complexity (number of medications and Medication Regimen Complexity Index; MRCI) and use of selected medication classes were exposure variables. Outcomes were occurrence of readmission within 30 and 90 days, and time to readmission within 90 days. Logistic and Cox hazards regression were used to identify factors associated with readmission. Overall, 50 patients (24%) were readmitted within 30 days, while 81 (40%) were readmitted within 90 days. Mean time to readmission within 90 days was 66 (SD 34) days. Medication appropriateness and regimen complexity were not independently associated with 30- or 90-day hospital readmissions in older adults with CKD, whereas use of renin-angiotensin blockers was associated with reduced occurrence of 30-day (adjusted OR 0.39; 95% CI 0.19–0.79) and 90-day readmissions (adjusted OR 0.45; 95% CI 0.24–0.84) and longer time to readmission within 90 days (adjusted HR 0.52; 95% CI 0.33–0.83). This finding highlights the importance of considering the potential benefits of individual medications during medication review in older CKD patients.

Highlights

Chronic kidney disease (CKD) is associated with a substantial risk of cardiovascular-related morbidity and mortality [1]
Additional laboratory and clinical information of the included patients are presented in the attached Supplementary Material
While half of the patients were on diuretics, nearly a third of them were prescribed calcium channel blockers (28%) and mineralocorticoid antagonists (25%)

Summary

Introduction

Chronic kidney disease (CKD) is associated with a substantial risk of cardiovascular-related morbidity and mortality [1]. Cardiovascular diseases are among the primary causes of morbidity and mortality in patients with CKD [2]. Pharmacological treatment in patients with CKD is largely directed at preventing and managing these cardiovascular problems. In addition to these comorbidities, CKD-related complications, such as anaemia and bone and mineral disorders, further complicate pharmacological approaches when treating these patients. Due to comorbidities and disease complications, the use of multiple medications in patients with CKD is often unavoidable, increasing the risk of exposure to medication-related problems that can lead to adverse drug events [4]. The suboptimal and/or inappropriate use of such medications could potentially lead to poor patient and clinical outcomes

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Results