Skip to main content
SpringerLink
Log in

The Number of Medications Is Associated with Fractures in a Population of Dialyzed Older Patients with Frailty

  • Brief Report
  • Clinics and Public Health
  • Published:
The Journal of Frailty & Aging Aims and scope Submit manuscript

Abstract

Older persons with chronic kidney disease (CKD) undergoing hemodialysis represent a growing portion of patients characterized by high vulnerability but still marginally studied. This study aimed at exploring the relationship between the number of prescriptions and fractures in older patients with CKD undergoing hemodialysis. A 24-item Frailty Index (FI) based on sociodemographic, clinical and biological data was computed. Unadjusted and adjusted logistic regression models were performed to test the association of prescribed medications with history of fractures. A total of 107 older patients undergoing hemodialysis (38 [35.5%] women, mean age 79.1 standard deviation, SD=7.7) were included in the study. Mean number of prescribed medications was 9.9 (SD=3.9) and was significantly associated with fractures (OR 1.18, 95% CI 1.06–1.32, p=0.003), even after adjustment for potential confounders (OR 1.16, 95% CI 1.03–1.30, p=0.016). If these results will be confirmed, interventions based on deprescribing will become essential in older persons undergoing hemodialysis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Maher RL, Hanlon JT, Hajjar ER. Clinical Consequences of Polypharmacy in Elderly. Expert Opin Drug Saf. 2014 Jan;13(1): https://doi.org/10.1517/14740338.2013.827660.

  2. Masnoon N, Shakib S, Kalisch-Ellett L, Caughey GE. What is polypharmacy? A systematic review of definitions. BMC Geriatr. 2017 Oct 10;17:230; https://doi.org/10.1186/s12877-017-0621-2.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Musso CG, Oreopoulos DG. Aging and Physiological Changes of the Kidneys Including Changes in Glomerular Filtration Rate. Nephron Physiol. 2011;119(Suppl. 1):p1–5; https://doi.org/10.1159/000328010.

    Article  Google Scholar 

  4. Bushardt RL, Massey EB, Simpson TW, Ariail JC, Simpson KN. Polypharmacy: Misleading, but manageable. Clin Interv Aging. 2008 Jun;3(2):383–9; https://doi.org/10.2147/CIA.S2468.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Rodrigues J, Cuppari L, Campbell KL, Avesani CM. Nutritional assessment of elderly patients on dialysis: pitfalls and potentials for practice. Nephrol Dial Transplant Off Publ Eur Dial Transpl Assoc — Eur Ren Assoc. 2017 Nov 1;32(11):1780–9; https://doi.org/10.1093/ndt/gfw471.

    Google Scholar 

  6. Checheriţă IA, Turcu F, Dragomirescu RF, Ciocâlteu A. Chronic complications in hemodialysis: correlations with primary renal disease. Romanian J Morphol Embryol Rev Roum Morphol Embryol. 2010;51(1):21–6.

    Google Scholar 

  7. Fink JC, Chertow GM. Medication errors in chronic kidney disease: one piece in the patient safety puzzle. Kidney Int. 2009 Dec 1;76(11):1123–5; https://doi.org/10.1038/ki.2009.315.

    Article  PubMed  Google Scholar 

  8. Lai SW, Liao KF, Liao CC, Muo CH, Liu CS, Sung FC. Polypharmacy Correlates With Increased Risk for Hip Fracture in the Elderly: A Population-Based Study. Medicine (Baltimore). 2010 Sep;89(5):295–9; https://doi.org/10.1097/MD.0b013e3181f15efc.

    Article  PubMed  Google Scholar 

  9. Beaubrun AC, Kilpatrick RD, Freburger JK, Bradbury BD, Wang L, Brookhart MA. Temporal trends in fracture rates and postdischarge outcomes among hemodialysis patients. J Am Soc Nephrol JASN. 2013 Sep;24(9):1461–9; https://doi.org/10.1681/ASN.2012090916.

    Article  PubMed  Google Scholar 

  10. Braithwaite RS, Col NF, Wong JB. Estimating hip fracture morbidity, mortality and costs. J Am Geriatr Soc. 2003 Mar;51(3):364–70; https://doi.org/10.1046/j.1532-5415.2003.51110.x.

    Article  PubMed  Google Scholar 

  11. Searle SD, Mitnitski A, Gahbauer EA, Gill TM, Rockwood K. A standard procedure for creating a frailty index. BMC Geriatr. 2008 Sep 30;8(1):24; https://doi.org/10.1186/1471-2318-8-24.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Soldati A, Poggi MM, Azzolino D, Vettoretti S, Cesari M. Frailty index and adverse outcomes in older patients in haemodialysis. Arch Gerontol Geriatr. 2022 Jul 1;101:104673; https://doi.org/10.1016/j.archger.2022.104673.

    Article  PubMed  Google Scholar 

  13. Kimura H, Kalantar-Zadeh K, Rhee CM, Streja E, Sy J. Polypharmacy and Frailty among Hemodialysis Patients. Nephron. 2021;145(6):624–32; https://doi.org/10.1159/000516532.

    Article  CAS  PubMed  Google Scholar 

  14. Battistella M, Ng P. Addressing Polypharmacy in Outpatient Dialysis Units. Clin J Am Soc Nephrol. 2021 Jan 7;16(1):144–6; https://doi.org/10.2215/CJN.05270420.

    Article  Google Scholar 

  15. Wakasugi M, Yokoseki A, Wada M, Momotsu T, Sato K, Kawashima H, et al. Polypharmacy, chronic kidney disease, and incident fragility fracture: a prospective cohort study. J Bone Miner Metab [Internet]. 2021 Nov 3 [cited 2022 Jan 14]; Available from: https://doi.org/10.1007/s00774-021-01272-9

  16. Cook WL, Jassal SV. Functional dependencies among the elderly on hemodialysis. Kidney Int. 2008 Jun 1;73(11):1289–95; https://doi.org/10.1038/ki.2008.62.

    Article  CAS  PubMed  Google Scholar 

Download references

Funding

Funding: none.

Author information

Authors and Affiliations

  1. Department of Clinical and Community Sciences, University of Milan, Via Camaldoli, 64 - 20138, Milan, Italy

    Domenico Azzolino & M. Cesari

  2. Geriatric Unit, IRCCS Istituti Clinici Scientifici Maugeri, Milan, Italy

    Domenico Azzolino & M. Cesari

  3. Unit of Nephrology, Dialysis and Kidney Transplantation, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico di Milano, Milano, Italy

    S. Vettoretti

  4. Specialisation School in Geriatrics, University of Milan, Milan, Italy

    M. M. Poggi & A. Soldati

Authors
  1. Domenico Azzolino
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. S. Vettoretti
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M. M. Poggi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. A. Soldati
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. M. Cesari
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Author contributions: DA and MC contributed to conceptualizing and writing the manuscript. SV, MMP and AS edited and revised manuscript. DA, SV, MMP, AS, and MC approved the final version of manuscript.

Corresponding author

Correspondence to Domenico Azzolino.

Additional information

Conflict of interest: The authors declare no conflict of interest.

Sponsor’s Role: none.

Electronic supplementary material

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Azzolino, D., Vettoretti, S., Poggi, M.M. et al. The Number of Medications Is Associated with Fractures in a Population of Dialyzed Older Patients with Frailty. J Frailty Aging 12, 244–246 (2023). https://doi.org/10.14283/jfa.2023.5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.14283/jfa.2023.5

Key words

Search

Navigation