Kidney Week

Abstract: TH-PO1074

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

Session Information

• CKD: Epidemiology, Risk Factors, Prevention - I
  October 25, 2018 | Location: Exhibit Hall, San Diego Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: CKD (Non-Dialysis)

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

Authors

• Hayward, Samantha JL, North Bristol NHS Trust, Bristol, United Kingdom

Samantha JL Hayward,

• Hole, Barnaby D., University of Bristol, Bristol, United Kingdom

Barnaby D. Hole,

• Denholm, Rachel, University of Bristol, Bristol, United Kingdom

Rachel Denholm,

• Duncan, Polly R., University of Bristol, Bristol, United Kingdom

Polly R. Duncan,

• Fraser, Simon DS, University of Southampton, UK, Southampton, United Kingdom

Simon DS Fraser,

• Morris, James E., University of Southampton, UK, Southampton, United Kingdom

James E. Morris,

• Payne, Rupert A., University of Bristol, Bristol, United Kingdom

Rupert A. Payne,

• Roderick, Paul J., University of Southampton, UK, Southampton, United Kingdom

Paul J. Roderick,

• Evans, Marie, Karolinska Institutet, Stockholm, Sweden

Marie Evans,

• Postorino, Maurizio, G.O.M Bianchi-Melacrino-Morelli, Reggio Calabria, Italy

Maurizio Postorino,

• Wanner, Christoph, University Hospital, Wuerzburg, Germany

Christoph Wanner,

• Dekker, Friedo W., Leiden University Medical Center , Leiden, Netherlands

Friedo W. Dekker,

• Jager, Kitty J., Academic Medical Center, Amsterdam, Netherlands

Kitty J. Jager,

• Caskey, Fergus J., North Bristol NHS Trust, Bristol, United Kingdom

Fergus J. Caskey,

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