Kidney Function, Polypharmacy, and Potentially Inappropriate Medication Use in a Community-Based Cohort of Older Adults
Chronic kidney disease (CKD) afflicts many older adults and increases the risk for medication-related adverse events.
The aim of this study was to assess the prevalence and associated morbidity and mortality of polypharmacy (use of several medications concurrently), and potentially inappropriate medication (PIM) use in older adults, looking for differences by CKD status.
We quantified medication and PIM use (from Beers criteria, the Screening Tool of Older People’s Prescriptions, and Micromedex®) by level of estimated glomerular filtration rate (eGFR) for participants aged 65 years or older attending a baseline study visit in the Atherosclerosis Risk in Communities study (n =6392). We used zero-inflated negative binomial and Cox proportional hazards regressions to assess the relationship between baseline polypharmacy, PIM use, and subsequent hospitalization and death.
Mean age at baseline was 76 (± 5) years, 59% were female, and 29% had CKD (eGFR < 60 ml/min/1.73 m2). Overall, participants reported 6.1 (± 3.5) medications and 2.3 (± 2.2) vitamins/supplements; 16% reported ≥ 10 medications; 31% reported a PIM based on their age. On average, participants with CKD reported more medications. A PIM based on kidney function was used by 36% of those with eGFR < 30 ml/min/1.73 m2. Over a median of 2.6 years, more concurrent medications were associated with higher risk of hospitalization and death, but PIM use was not. While those with CKD had higher absolute risks, there was no difference in the relative risks associated with greater numbers of medications by CKD status.
Polypharmacy and PIM use were common, with greater numbers of medications associated with higher risk of hospitalization and death; relative risks were similar for those with and without CKD.
Preliminary data from this study were presented in a spotlight poster session at the 33rd International Conference of Pharmacoepidemiology and Therapeutic Risk Management, Montreal, QC, Canada, 27–30 August 2017. The authors thank the staff and participants of the ARIC study for their important contributions
Research idea and study design: AS, GCA, SHB, JC, MEG. Data analysis/interpretation: AS, GCA, SHB, JC, MEG. Statistical analysis: AS, MEG. Supervision or mentorship: GCA, JC, MEG. Each author contributed meaningfully to manuscript content during its preparation or revision, and accepts accountability for the overall work.
Compliance with Ethical Standards
Alex Secora, the principal author, is supported by grant T32 HL007024 from the NHLBI, National Institutes of Health; Morgan Grams is supported by grant K08DK092287 from the National Institute of Diabetes and Digestive and Kidney Diseases; and G. Caleb Alexander is supported by 1 U01 FD004977-02 from the US FDA. The ARIC study is performed as a collaborative investigation supported by contracts HHSN268201100005C, HHSN268201100006C, HHSN268201100007C, HHSN268201100008C, HHSN268201100009C, HHSN268201100010C, HHSN268201100011C, and HHSN268201100012C from the NHLBI. The funding sources had no role in the design and conduct of the study, analysis or interpretation of the data, and preparation or final approval of the manuscript prior to publication.
Conflict of interest
Dr. G. Caleb Alexander is Chair of the FDA’s Peripheral and Central Nervous System Advisory Committee, has served as a paid advisor to IQVIA, serves on the advisory board of MesaRx Innovations, is a member of OptumRx’s National P&T Committee, and holds equity in Monument Analytics, a healthcare consultancy whose clients include the life sciences industry as well as plaintiffs in opioid litigation. This arrangement has been reviewed and approved by Johns Hopkins University in accordance with its conflict of interest policies. Alex Secora, G. Caleb Alexander, Shoshana H. Ballew, Josef Coresh and Morgan E. Grams declare that they have no conflicts of interest relevant to the content of this study.
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