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Medication Exposure and Health Outcomes in Older Patients with End-Stage Kidney Disease: A Prospective Study Undertaken in New Zealand

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Abstract

Background

The impact of multiple medication exposure on health outcomes among older patients with end-stage kidney disease (ESKD) is unknown.

Objective

The objective of this study was to identify the impact of medicine exposure on hospitalisation rates and mortality in a prospective longitudinal observational study of older dialysis patients.

Methods

Patient demographics, medication use, hospitalisation, mortality and co-morbidity data were collected through the prospective longitudinal cohort study DOS65 + (Dialysis Outcomes in those aged ≥ 65 years Study) (n = 225). Medication exposure was measured by the total number of individual medications and the number of predetermined ‘medication groups’. Associations between medications prescribed at recruitment and health outcomes as measured by hospitalisation and mortality were assessed by univariate and multivariable regression analyses.

Results

Older ESKD patients were exposed to a median of ten (0–20) medications and eight (0–15) medication groups. Multivariate analyses estimate each additional medication increased mortality risk by 8% (relative risk [RR] = 1.08; 95% confidence interval [CI] 1.07–1.09); each medication group increased mortality risk by 11% (RR = 1.11; 95% CI 1.09–1.12). Similar trends were observed for hospitalisation. Certain medication groups were associated with reduced hospitalisation rates, namely angiotensin converting enzyme (ACE) inhibitors/angiotensin receptor blockers (RR = 0.62; 95% CI 0.53–0.72) and dihydropyridines (RR = 0.64; 95% CI 0.54–0.76). Warfarin, gastric acid suppressants, diuretics and β-blockers were associated with increased hospitalisation rates. Warfarin was associated with an increased mortality rate (RR = 1.40; 95% CI 1.19–1.65).

Conclusions

Multiple medication exposure was prevalent in this older ESKD population, and was associated with an increased risk of mortality and hospitalisation. While this study is not able to determine the cause of these relationships, review of medication use is warranted in this population.

Trial Registration

ACTRN12611000024943.

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Acknowledgements

Sashika Samaranayaka was a recipient of an Otago Medical Research Foundation–Metro Realty summer studentship.

Author information

Authors and Affiliations

  1. Department of Medicine, Dunedin School of Medicine, University of Otago, PO Box 56, Dunedin, New Zealand

    Sashika Samaranayaka, Robert J. Walker & John W. B. Schollum

  2. Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand

    Ari Samaranayaka & Sarah Derrett

Authors
  1. Sashika Samaranayaka
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  2. Robert J. Walker
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  3. Ari Samaranayaka
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  4. Sarah Derrett
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Contributions

RW and SD were responsible for the research idea and design; all authors contributed to data analyses and interpretation, manuscript authorship and review; AS and SS were responsible for the statistical analyses. SS was supervised by RW, SD, JS and AS.

Corresponding author

Correspondence to Robert J. Walker.

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Funding

The DOS65 + (Dialysis Outcomes in those aged ≥ 65 years Study) was funded by the Health Research Council (HRC) of New Zealand (HRC 10/354). The study was investigator-initiated and analysed, with no contribution from the HRC to the analyses.

Conflict of interest

Sashika Samaranayaka, Robert Walker, Ari Samaranayaka, Sarah Derrett and John Schollum declare that they have no conflicts of interest relevant to the content of this study.

Ethical approval

The study was approved by the New Zealand Multi-Regional Ethics Committee (MEC/10/084) and registered in Australian New Zealand clinical trials registry (ACTRN12611000024943).

Electronic supplementary material

Below is the link to the electronic supplementary material.

40266_2018_582_MOESM1_ESM.xlsx

Supplementary Table 1: Detailed table with the complete data for four multivariable Negative Binomial models showing the effect of medication exposure on risk of hospitalisation after adjusting for confounders. Supplementary Table 2: Detailed table with the complete data for four Modified Poisson models showing the effect of medication exposure on risk of death after adjusting for confounders (XLSX 21 kb)

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Samaranayaka, S., Walker, R.J., Samaranayaka, A. et al. Medication Exposure and Health Outcomes in Older Patients with End-Stage Kidney Disease: A Prospective Study Undertaken in New Zealand. Drugs Aging 35, 1005–1015 (2018). https://doi.org/10.1007/s40266-018-0582-y

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