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Abstract: TH-PO1074

Polypharmacy in Older Patients Developing Advanced CKD in 6 European Countries: Results from the EQUAL Study

Session Information

Category: CKD (Non-Dialysis)

  • 1902 CKD (Non-Dialysis): Clinical, Outcomes, and Trials

Authors

  • Hayward, Samantha JL, North Bristol NHS Trust, Bristol, United Kingdom
  • Hole, Barnaby D., University of Bristol, Bristol, United Kingdom
  • Denholm, Rachel, University of Bristol, Bristol, United Kingdom
  • Duncan, Polly R., University of Bristol, Bristol, United Kingdom
  • Fraser, Simon DS, University of Southampton, UK, Southampton, United Kingdom
  • Morris, James E., University of Southampton, UK, Southampton, United Kingdom
  • Payne, Rupert A., University of Bristol, Bristol, United Kingdom
  • Roderick, Paul J., University of Southampton, UK, Southampton, United Kingdom
  • Evans, Marie, Karolinska Institutet, Stockholm, Sweden
  • Postorino, Maurizio, G.O.M Bianchi-Melacrino-Morelli, Reggio Calabria, Italy
  • Wanner, Christoph, University Hospital, Wuerzburg, Germany
  • Dekker, Friedo W., Leiden University Medical Center , Leiden, Netherlands
  • Jager, Kitty J., Academic Medical Center, Amsterdam, Netherlands
  • Caskey, Fergus J., North Bristol NHS Trust, Bristol, United Kingdom

Group or Team Name

  • On behalf of the EQUAL Study investigators
Background

Polypharmacy is increasing in the general population. We aimed to describe associations with the number of prescribed medications to identify patients who are most likely to experience polypharmacy.

Methods

The EQUAL Study follows patients aged 65+ years from 6 European countries whose eGFR dropped to ≤20 ml/min/1.73m2 for the first time. Demographic, clinical and medication data were collected at baseline. Univariable and multivariable linear regression were used to determine the association between baseline factors (age, sex, education, eGFR, comorbidity and country) and number of medications.

Results

Recruited patients (n=1647) had a mean age of 76.4 years (SD 6.7) and 65.2% were male. Multimorbidity was common; the mean Charlson Comorbidity Index (CCI) was 7 (SD 1.9). The mean number of medications was 8 (SD 3.6, range 0-21) and 75% of patients were on >5 medications.

In the univariable analysis, all age groups except >85 years were on more medications than the reference group (65-70 years). Each additional CCI point was associated with 0.48 additional medication (p<0.001). As education attainment increased, people were on fewer medications. German patients were on 1.72 additional medications and Swedish patients were on 3.68 fewer medications when compared to the UK (both p<0.001). Sex and eGFR had no association with number of medications.

After adjusting for country, education and CCI, the number of medications was only associated with age in the most elderly group. Those >85 years were on 1.41 fewer medications compared to those aged 65-70, table 1.

Conclusion

Polypharmacy was common amongst EQUAL recruits, but the relationship with age is complex. Unlike the general population where polypharmacy increases even to the oldest age groups, the oldest EQUAL recruits were on fewer medications. This contrast may reflect de-prescribing.

Table 1. Linear regression of number of medications by age group
Age group (years)UnivariableMultivariable (country, education)Multivariable (country, education, CCI)
Regression coefficientP value95% CIRegression coefficientP value95% CIRegression coefficientP value95% CI
65-70Reference--------
71-750.92<0.0010.41-1.430.420.109-0.09-0.94-0.060.817-0.57-0.45
76-800.670.0090.17-1.170.420.106-0.09-0.92-0.200.443-0.70-0.30
81-850.640.0210.10-1.200.320.276-0.25-0.89-0.650.028-1.24- -0.07
>850.140.685-0.56-0.85-0.690.056-1.4-0.02-1.41<0.001-2.11- -0.71