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Abstract: PO1694

Potentially Inappropriate Antihypertensive Medications and Mortality in Older Adults on Hemodialysis

Session Information

Category: Geriatric Nephrology

  • 1100 Geriatric Nephrology

Authors

  • Hall, Rasheeda K., Duke University School of Medicine, Durham, North Carolina, United States
  • Morton, Sarah N., Duke University School of Medicine, Durham, North Carolina, United States
  • Wilson, Jonathan A., Duke University School of Medicine, Durham, North Carolina, United States
  • Ephraim, Patti, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
  • Boulware, L. Ebony, Duke University School of Medicine, Durham, North Carolina, United States
  • St. Peter, Wendy L., University of Minnesota System, Minneapolis, Minnesota, United States
  • Colon-emeric, Cathleen, Duke University School of Medicine, Durham, North Carolina, United States
  • Pendergast, Jane F., Duke University School of Medicine, Durham, North Carolina, United States
  • Scialla, Julia J., University of Virginia, Charlottesville, Virginia, United States
Background

Older patients on hemodialysis often have difficult to control hypertension, but also suffer from orthostatic or post-dialysis hypotension. Some orthostasis-causing antihypertensives (i.e., central alpha agonists (CAA) and alpha blockers (AB)), are considered potentially inappropriate medications (PIMs) for older adults because they carry more risk than benefit. We sought to determine if these PIMs are associated with mortality risk among older adults on hemodialysis.

Methods

Using USRDS analytic files, we studied adults aged ≥66 years initiating in-center hemodialysis (ICHD) from 2013-2014 with a Medicare Part D prescription for CAA or AB at initiation. All had Medicare Parts A, B, and D ≥1 year prior to initiation, no hospice care within prior 6 months, and continued ICHD for ≥120 days. We classified patients as continuing or discontinuing CAA/AB at 120 days and examined risk of death over 2 years using Cox models adjusted for demographics, dual Medicare and Medicaid eligibility, comorbidity index, diabetes, ESRD cause, hospitalization count in prior 12 months, pre-dialysis nephrology care, facility for-profit status/region, nursing home residence, and functional limitation (CMS form 2728). We tested interaction between CAA/AB continuation and functional limitation. We censored models for discontinued dialysis, hospice, loss to follow up, modality change, and transplant.

Results

Of 5,981 patients, mean age 75.6±6.5, 51.4% women, and 24.6% black. Most [65.5% (n=3,920)] continued CAA/AB prescription at 120 days. Compared to those who discontinued, those who continued were more likely to be black (26.3 vs. 21.3%), dual eligible (31.5 vs. 27.3%), and have no functional limitations (84.1 vs. 79.8%). With a smaller proportion of deaths compared to discontinuers (17.3 vs. 20.9%), continuation of CAA/AB was associated with a lower hazard of death (unadjusted HR 0.78, 95% CI: 0.68-0.90). After adjustment, this was attenuated and not significant (aHR 0.88, 95% CI: 0.76-1.01). The association was not modified by functional limitations (p=0.54).

Conclusion

We did not find increased mortality among older adults on ICHD who continue CAA or AB prescriptions after 120 days, providing some reassurance on their use in all older adults on ICHD.

Funding

  • Other NIH Support