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Abstract: FR-PO1040

Thirty-Day Refill Gap in Prescription for P2Y12 Inhibitor Predicts Death in Dialysis Patients

Session Information

Category: Hypertension and CVD

  • 1402 Hypertension and CVD: Clinical, Outcomes, and Trials

Authors

  • Mandalapu, Rajendra, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States
  • Dai, Junqiang, University of Kansas Medical Center, Kansas City, Kansas, United States
  • Hunt, Suzanne L., University of Kansas Medical Center, Kansas City, Kansas, United States
  • Phadnis, Milind A., University of Kansas Medical Center, Kansas City, Kansas, United States
  • Rasu, Rafia, University of North Texas Health Science Center, Fort Worth, Texas, United States
  • Jain, Nishank, Little Rock VA Hospital, Little Rock, Arkansas, United States
Background

It remains unclear whether gaps in refill of prescriptions for oral P2Y12 inhibitors (P2Y12-I) is associated with mortality in patients on chronic dialysis (ESRD).

Methods

USRDS registry from 2011 to 2015 was used to capture new P2Y12-I prescriptions for ESRD patients. The cohort was followed until death, kidney transplantation, switching between P2Y12-I, or lost to follow-up. After flagging and censoring key variables, all-cause death was counted and prescription refill pattern was ascertained for the first 6 months from the index date. Two major patterns were recognized: continuous users with no gaps in refills of 30 days and users with ≥30 days’ gap in refills. Cox proportional regression (CPR) model analyzed association between all-cause death and ≥30 days’ gap in prescription refills compared to continuous users with no such gaps in refill.

Results

Of the 32,886 patients in the cohort, median age of the cohort 64 years (IQR: 55 years, 72 years). 54% were male, 41% Caucasians, 36% African American and 18% Hispanic. 93% on hemodialysis, 7% on peritoneal dialysis, and average time on dialysis 3.8 years. Median modified Liu Index was 7 (IQR: 4, 10), and median number of baseline medications were 7 (IQR: 5, 10). During the first 6 months from the index date, there were 14,907 patients who filled prescriptions continuously without 30 days gap while 16,810 patients had ≥30 days’ gap in refill. Compared to continuous refill pattern, ≥ 30 days’ gap in refill of P2Y12-I prescription was associated with all-cause death, unadjusted hazard ratio (HR) 1.10 (95%CI: 1.06, 1.15) and adjusted HR 1.16 (95%CI: 1.11, 1.20).

Conclusion

Gaps in P2Y12-I prescription refills of ≥30 days among ESRD patients is independently associated with short term all-cause death.

Funding

  • Other NIH Support