Abstract
Although polypharmacy is common among patients on hemodialysis (HD), its association with prognosis remains unclear. This study aimed to elucidate the association between the number of prescribed medicines and all-cause mortality in patients on HD, accounting for essential medicines (i.e., antihypertensives, antidiabetic medicines, and statins) and non-essential medicines. We evaluated 339 patients who underwent maintenance HD at Nagasaki Renal Center between July 2011 and June 2012 and followed up until June 2021. After adjusting for patient characteristics, the number of regularly prescribed medicines (10.0 ± 4.0) was not correlated with prognosis (hazard ratio [HR]: 1.01, 95% confidence interval [CI] 0.97–1.05, p = 0.60). However, the number of non-essential medicines (7.9 ± 3.6) was correlated with prognosis (HR: 1.06, 95% CI 1.01–1.10, p = 0.009). Adjusting for patient characteristics, patients who were prescribed more than 10 non-essential medicines were found to have a significantly higher probability of mortality than those prescribed less than five non-essential medicines, with a relative risk of 2.01 (p = 0.004). In conclusion, polypharmacy of non-essential medicines increases the risk of all-cause mortality in patients on HD. As such, prescribing essential medicines should be prioritized, and the clinical relevance of each medicine should be reviewed by physicians and pharmacists.
Highlights
Number of regularly prescribed medicines excluding the essential medicines exerts a favorable prognostic effect in patients on H D16
The mean hemoglobin A1c level, which was only available in patients with diabetes, was 5.8 ± 1.2%
The risk of mortality was twofold higher in patients in QB5 than in those in QB1 (Fig. 3d). This retrospective cohort study elucidated the association between polypharmacy and prognosis in patients on HD and found that there was no significant association between the total number of prescribed medicines and prognosis, the number of prescribed non-essential medicines was associated with prognosis after adjusting for clinically important confounding factors
Summary
Number of regularly prescribed medicines excluding the essential medicines exerts a favorable prognostic effect in patients on H D16. Our previous study found a positive effect of pitavastatin on mortality in patients undergoing H D17. The association between polypharmacy and prognosis in the context of essential medicines (e.g., antihypertensive and antidiabetic medicines) and non-essential medicines in patients on HD remains unclear. We hypothesized that the number of prescribed non-essential medicines is correlated with prognosis in these patients. This study aimed to elucidate the association between the number of prescribed medicines and all-cause mortality in patients receiving HD, considering the essential medicines
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