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Polypharmacy Predicts Onset and Transition of Frailty, Malnutrition, and Adverse Outcomes in Peritoneal Dialysis Patients

  • Original Research
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The journal of nutrition, health & aging

Abstract

Background

Polypharmacy, frailty and malnutrition are known predictors of adverse outcomes in dialysis patients. Little has reported about their interaction and composite prognostic values. We aimed to describe the interaction between polypharmacy, frailty, nutrition, hospitalization, and survival in peritoneal dialysis patients.

Methods

In this prospective cohort study, we recruited 573 peritoneal dialysis patients. Drug burden was measured by medication number and daily pill load. Frailty and nutrition were assessed by the validated Frailty Score (FQ) and Subjective Global Assessment (SGA) respectively. All patients were followed for two years. Primary outcome was all-cause mortality. Secondary outcomes were fall and fracture episodes, hospitalization, change in FQ and SGA.

Results

At baseline, each patient took 7.5 ± 2.6 medications with 15.5 ± 8.5 tablets per day. Medication number, but not daily pill load predicted baseline FQ (p = 0.004) and SGA (p = 0.03). Over 2 years, there were 69 fall and 1,606 hospitalization episodes. In addition, 148 (25.8%) patients died, while FQ and SGA changed by 0.73 ± 4.23 and −0.07 ± 1.06 respectively in survivors. Medication number (hospitalization: p = 0.02, survival: p = 0.005), FQ (hospitalization: p < 0.001; survival: p = 0.01) predicted hospitalization and survival. Medication number also predicted fall episodes (p = 0.02) and frailty progression (p = 0.002). Daily pill load did not predict any of these outcomes.

Conclusions

Drug burden is high in peritoneal dialysis patients, and it carries important prognostic implication. Medication number but not pill load significantly predicted onset and progression of frailty, malnutrition, fall, hospitalization, and mortality.

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Data availability statement: Data available on request due to privacy/ethical restrictions.

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Acknowledgements

This study was supported by the Richard Yu Chinese University of Hong Kong (CUHK) PD Research Fund, and CUHK research accounts 6905134 and 7105912.

Funding

Funding sources: This study was supported by the Richard Yu Chinese University of Hong Kong (CUHK) PD Research Fund, and CUHK research accounts 6905134 and 7105912. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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Authors and Affiliations

  1. Carol & Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine & Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, NT, Hong Kong, China

    Gordon C.-K. Chan, J. K.-C. Ng, K.-M. Chow, P. M.-S. Cheng, M.-C. Law, C.-B. Leung, P. K.-T. Li & C.-C. Szeto

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  1. Gordon C.-K. Chan
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  2. J. K.-C. Ng
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  3. K.-M. Chow
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  4. P. M.-S. Cheng
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  5. M.-C. Law
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  6. C.-B. Leung
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  7. P. K.-T. Li
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  8. C.-C. Szeto
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Contributions

Author contributions: Gordon Chun-Kau CHAN: Conceptualization, Methodology, Data curation, Formal analysis, Writing — Original Draft, Project administration. Jack Kit-Chung NG: Investigation, Data curation, Writing — Review & Editing. Kai-Ming CHOW: Investigation. Phyllis Mei-Shan CHENG: Investigation. Man-Ching LAW: Investigation. Chi-Bon LEUNG: Investigation. Philip Kam-Tao LI: Supervision. Cheuk-Chun SZETO: Conceptualization, Methodology, Data curation, Writing — Review & Editing, Supervision.

Corresponding author

Correspondence to Gordon C.-K. Chan.

Ethics declarations

Conflict of interest statement: Dr. CC Szeto receives research grant and consultancy from Baxter Healthcare. The authors declare no other conflict of interest. The results presented in this paper have not been published previously in whole or part, except in abstract format.

Ethical standards: The study was conducted according to the guidelines of the Declaration of Helsinki and approved by the Institutional Review Board of Joint Chinese University of Hong Kong — New Territories East Cluster Clinical Research Ethics Committee (Approval number: CRE-2012.311).

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Informed consent statement: Informed consent was obtained from all subjects involved in the study.

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Chan, G.CK., Ng, J.KC., Chow, KM. et al. Polypharmacy Predicts Onset and Transition of Frailty, Malnutrition, and Adverse Outcomes in Peritoneal Dialysis Patients. J Nutr Health Aging 26, 1054–1060 (2022). https://doi.org/10.1007/s12603-022-1859-8

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