Medication Exposure and Health Outcomes in Older Patients with End-Stage Kidney Disease: A Prospective Study Undertaken in New Zealand
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The impact of multiple medication exposure on health outcomes among older patients with end-stage kidney disease (ESKD) is unknown.
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.
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.
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).
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.
Sashika Samaranayaka was a recipient of an Otago Medical Research Foundation–Metro Realty summer studentship.
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.
Compliance with Ethical Standards
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.
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).
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