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Impact of polypharmacy on all-cause mortality and hospitalization in incident hemodialysis patients: a cohort study

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Abstract

Background

Polypharmacy (PP) is common in end-stage chronic renal disease patients largely due to the presence of multiple comorbid conditions. Although PP is potentially harmful, its relationship with mortality and morbidity in hemodialysis patients currently remains unclear.

Methods

Study design: cohort study.

Setting: participants: one hundred and fifty-two initial hemodialysis patients (male, 88 patients; mean age, 70.3 years) were enrolled between February 2015 and March 2018 at Nobeoka Prefectural Hospital and Chiyoda Hospital.

Predictor: patients were divided into 2 groups according to PP (6 or more drug prescriptions or less) during admission and discharge for the initiation of hemodialysis.

Outcomes: all-cause mortality and hospitalization during the mean 2.8-year follow-up.

Measurements: hazard ratios (HRs) were estimated using Cox’s model for the relationships between PP and clinical outcomes and adjusted for potential confounders. The group with 5 or less drug prescriptions was set as a reference.

Results

The number of prescribed drugs per patient averaged 7.4 at admission and 7.0 at discharge for initial hemodialysis. One hundred (65.8%) and 94 patients (61.8%) had PP at admission and discharge, respectively. During the follow-up, 20 patients died and 71 were hospitalized. PP at admission did not correlate with outcomes, whereas that at discharge correlated with all-cause hospitalization.

Conclusions

PP at discharge may be associated with clinical outcomes. However, it remains unclear whether PP is the direct cause of outcomes or is simply a marker for an increased risk of outcomes.

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Authors and Affiliations

  1. Department of Hemovascular Medicine and Artificial Organs, Faculty of Medicine, University of Miyazaki, 5200 Kihara Kiyotake, Miyazaki city, Miyazaki, 889-1692, Japan

    Tatsunori Toida & Shouichi Fujimoto

  2. Department of Internal Medicine, Miyazaki Prefectural Nobeoka Hospital, Nobeoka City, Miyazaki, Japan

    Tatsunori Toida & Risa Takahashi

  3. Chiyoda Hospital, Hyuga city, Miyazaki, Japan

    Reiko Toida & Shigehiro Uezono

  4. Center for Medical Education and Career Development, Faculty of Medicine, University of Miyazaki, Miyazaki city, Miyazaki, Japan

    Hiroyuki Komatsu

  5. Division of Nephrology, Department of Internal Medicine, National Health Insurance Takachiho Town Hospital, Takachiho, Miyazaki, Japan

    Yuji Sato

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  1. Tatsunori Toida
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  2. Reiko Toida
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Correspondence to Tatsunori Toida.

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The authors have declared that no conflict of interest exists.

Ethical approval

This study was conducted in accordance with the principles contained in the Declaration of Helsinki and was approved by the Chiyoda Hospital and Miyazaki Prefectural Nobeoka Hospital Research Ethics Committees (Approval numbers: 23-1 and 20191004-3, respectively). This article does not contain any studies with animals performed by any of the authors.

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Informed consent was obtained from all individual participants included in the study.

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Toida, T., Toida, R., Takahashi, R. et al. Impact of polypharmacy on all-cause mortality and hospitalization in incident hemodialysis patients: a cohort study. Clin Exp Nephrol 25, 1215–1223 (2021). https://doi.org/10.1007/s10157-021-02094-9

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  • DOI: https://doi.org/10.1007/s10157-021-02094-9

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