The association between polypharmacy and health-related quality of life among non-dialysis chronic kidney disease patients

BACKGROUND AND OBJECTIVE: The United States government spends over 85 billion annually on treating non-dialysis chronic kidney disease (CKD). Patients with CKD are prescribed a multitude of medications to manage numerous comorbidities associated with CKD. Thus, this study aims to investigate the association between polypharmacy and health-related quality of life (HRQoL) in non-dialysis CKD patients. METHODS: This cross-sectional study utilized data from the Medical Expenditure Panel Survey (MEPS) from 2010 through 2019. We classified polypharmacy into three groups based on the number of medication classes: ≤ 4 (minor polypharmacy), 5 through 9 (major polypharmacy), and ≥ 10 (hyperpolypharmacy). To measure HRQoL, a Physical Component Summary (PCS) and a Mental Component Summary (MCS) were obtained from the 12-item Short-Form Health Survey version 2 and Veteran's Rand 12 item. We applied multivariable ordinary least squares regression to assess the association between polypharmacy and HRQoL in non-dialysis CKD patients. RESULTS: A total of 649 CKD patients (weighted n = 667, 989) were included. Patients with minor polypharmacy, major polypharmacy, and hyperpolypharmacy were 22. 27%, 48. 24%, and 29. 48%, respectively. Major polypharmacy and hyperpolypharmacy were significantly and negatively associated with lower PCS scores when compared with minor polypharmacy Beta = -3. 12 (95% CI: -3. 62, -2. 62), p-value<0. 001; Beta = -4. 13 (95CI: -4. 74, -3. 52), p-value<0. 001. Similarly, major polypharmacy and hyperpolypharmacy were significantly and negatively associated with lower MCS scores when compared to minor polypharmacy Beta = -0. 38 (95% CI: -0. 55, -0. 20), p-value<0. 001; Beta = -1. 70 (95% CI: -2. 01, -1. 40), p-value<0. 001. The top 5 classes of medications used by CKD patients were antihyperlipidemic (56. 31%), beta-adrenergic blockers (49. 71%), antidiabetics (42. 14%), analgesics (42. 17%), and diuretics (39. 65%). CONCLUSION: Our study found that both major polypharmacy and hyperpolypharmacy were associated with lower HRQoL among non-dialysis CKD patients. This study highlights the need for further evaluation of the combination of medications taken by non-dialysis CKD patients to minimize unnecessary and inappropriate medication use.