Prognostic impact of polypharmacy by drug essentiality in patients on hemodialysis

Q: What are the key findings of this study?

Polypharmacy of non-essential medicines significantly increased the risk of all-cause mortality in patients on hemodialysis (HR 1.06 per additional medicine).

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Hemodialysis (n=339). Intervention: Polypharmacy of non-essential medicines vs. Fewer non-essential medicines. Primary outcome: All-cause mortality (HR 1.06, 95% CI 1.01-1.10, p=0.009).

Q: What does this research mean for the field?

Polypharmacy of non-essential medicines significantly increases the risk of all-cause mortality in patients on hemodialysis, whereas the total number of prescribed medicines does not. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Mineaki Kitamura; K Yamaguchi; Yuki Ota; Satoko Notomi; Maya Komine; Rika Etoh; Takashi Harada; Satoshi Funakoshi; Hiroshi Mukae; Tomoya Nishino

doi:10.1038/s41598-021-03772-0

December 20, 2021Scientific ReportsOpen Access

Prognostic impact of polypharmacy by drug essentiality in patients on hemodialysis

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Key result

Each additional non-essential medicine is associated with ~6% higher mortality risk in hemodialysis patients.

HR 1.06
95% CI 1.01-1.10
P=0.009
n=339

Figures

Why the study?

Polypharmacy is common among patients on hemodialysis, but its association with prognosis remains unclear.

Does polypharmacy of non-essential medicines increase all-cause mortality in patients on hemodialysis?

Study Design

Type

Cohort (n=339)

Multicenter

No

Structured PICO

Does polypharmacy of non-essential medicines increase all-cause mortality in patients on hemodialysis?

P

Population

339 adults (age ≥20 years) undergoing maintenance hemodialysis (3 sessions a week for >3 months) at a single center in Japan, mean age 67.3 years, 57% male.

I

Intervention

Polypharmacy of non-essential medicines (regularly prescribed oral medicines excluding antihypertensives, diuretics, antidiabetics, and statins)

C

Comparator

Lower number of prescribed non-essential medicines (e.g., <5 non-essential medicines)

O

Outcome

All-cause mortalityhard clinical

Main Result

Effect estimate: HR 1.06 (95% CI 1.01-1.10)

p-value: p=0.009

Polypharmacy of non-essential medicines, but not essential medicines, increases the risk of all-cause mortality in patients on maintenance hemodialysis.

Limitations

Prescription profiles were only investigated at baseline and could not be followed up during the observation period.
Drug-drug interactions could not be fully assessed using the multivariable regression models.
The number of available medicines increased after the study period, which might have increased the number of prescribed medicines during observation.
Only oral drugs were included, excluding intravenous medicines.
The dose of the medicines and pill burdens were not considered.
Prescription profiles only investigated at the beginning of the study
Could not assess drug-drug interactions using multivariable regression models
Number of available medicines increased after the study period
Only focused on oral drugs and excluded intravenous medicines
Did not consider the dose of the medicines

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Implication

Supports caution with non-essential polypharmacy in hemodialysis; leaves open causal benefit of deprescribing.

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.

Discussion

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Cite This Study

Kitamura et al. (2021) conducted a cohort in Hemodialysis (n=339). Polypharmacy of non-essential medicines vs. Fewer non-essential medicines was evaluated on All-cause mortality (HR 1.06, 95% CI 1.01-1.10, p=0.009). Polypharmacy of non-essential medicines significantly increased the risk of all-cause mortality in patients on hemodialysis (HR 1.06 per additional medicine).

synapsesocial.com/papers/6a18e0dec9d74cf65281fc32 https://doi.org/10.1038/s41598-021-03772-0

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Prognostic impact of polypharmacy by drug essentiality in patients on hemodialysis

Figures

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Prognostic impact of polypharmacy by drug essentiality in patients on hemodialysis

Figures

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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