Abstract
BackgroundPolypharmacy, often defined as the concomitant use of ≥ 5 medications, has been identified as a significant global public health threat. Aging and multimorbidity are key drivers of polypharmacy and have been linked to a broad range of adverse health outcomes and mortality. Patients with chronic kidney disease (CKD) are particularly at high risk of polypharmacy and use of potentially inappropriate medications given the numerous risk factors and complications associated with CKD. The aim of this systematic review will be to assess the prevalence of polypharmacy among adult patients with CKD, and the potential association between polypharmacy and adverse health outcomes within this population.Methods/designWe will search empirical databases such as MEDLINE, Embase, Cochrane Library, CINAHL, Web of Science, and PsycINFO and grey literature from inception onwards (with no language restrictions) for observational studies (e.g., cross-sectional or cohort studies) reporting the prevalence of polypharmacy in adult patients with CKD (all stages including dialysis). Two reviewers will independently screen all citations, full-text articles, and extract data. Potential conflicts will be resolved through discussion. The study methodological quality will be appraised using an appropriate tool. The primary outcome will be the prevalence of polypharmacy. Secondary outcomes will include any adverse health outcomes (e.g., worsening kidney function) in association with polypharmacy. If appropriate, we will conduct random effects meta-analysis of observational data to summarize the pooled prevalence of polypharmacy and the associations between polypharmacy and adverse outcomes. Statistical heterogeneity will be estimated using Cochran’s Q and I2 index. Additional analyses will be conducted to explore the potential sources of heterogeneity (e.g., sex, kidney replacement therapy, multimorbidity).DiscussionGiven that polypharmacy is a major and a growing public health issue, our findings will highlight the prevalence of polypharmacy, hazards associated with it, and medication thresholds associated with adverse outcomes in patients with CKD. Our study will also draw attention to the prognostic importance of improving medication practices as a key priority area to help minimize the use of inappropriate medications in patients with CKD.Systematic review registrationPROSPERO registration number: [CRD42020206514].
Highlights
Polypharmacy, often defined as the concomitant use of ≥ 5 medications, has been identified as a significant global public health threat
Given that polypharmacy is a major and a growing public health issue, our findings will highlight the prevalence of polypharmacy, hazards associated with it, and medication thresholds associated with adverse outcomes in patients with chronic kidney disease (CKD)
Our study will draw attention to the prognostic importance of improving medication practices as a key priority area to help minimize the use of inappropriate medications in patients with CKD
Summary
To the best of our knowledge, this review is the first to comprehensively assess the prevalence of polypharmacy in patients with CKD as well as reporting the incidence of adverse health outcomes associated with polypharmacy in such patients. A potential limitation of this study could be non-uniform reporting of adverse outcomes and their associations with polypharmacy. This could make it difficult to identify adverse outcomes associated with use of medications in the CKD population. Another limitation could be that identified studies are mostly of low quality which could impact on the final reporting of our outcomes. The quality of evidence for the primary outcome, i.e., prevalence of polypharmacy, will be assessed as “very low” to “high” in accordance to the Grading of Recommendations Assessment, Development and Evaluation
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