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Kidney Week

Abstract: PO0585

The Practical Patterns of Medication and the Association Between CKD Stage and Polypharmacy: The Fukuoka Kidney Disease Registry Study

Session Information

Category: CKD (Non-Dialysis)

  • 2102 CKD (Non-Dialysis): Clinical, Outcomes, and Trials

Authors

  • Hara, Masatoshi, Department of Internal Medicine, Fukuoka Dental College, Fukuoka, Fukuoka, Japan
  • Tanaka, Shigeru, Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
  • Torisu, Kumiko, Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
  • Tokumoto, Masanori, Department of Internal Medicine, Fukuoka Dental College, Fukuoka, Fukuoka, Japan
  • Tsuruya, Kazuhiko, Department of Nephrology, Nara Medical University, Kashihara, Nara, Japan
  • Ooboshi, Hiroaki, Department of Internal Medicine, Fukuoka Dental College, Fukuoka, Fukuoka, Japan
  • Nakano, Toshiaki, Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
  • Kitazono, Takanari, Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
Background

Polypharmacy has emerged as one of the important medical and socioeconomic problems in an aging society. Chronic kidney disease (CKD) is also one of the important medical problems for older people. However, the extent to which CKD is involved in polypharmacy still has not been fully explored yet.

Methods

We examined 3,968 Japanese CKD patients using baseline data from a multicenter prospective cohort study in a cross-sectional manner. We used the baseline data of prescribed medicines on medical records. We evaluated the association between CKD stage and polypharmacy (defined as ≥6 medicines/day; Kojima T, et al. Geriatr Gerontol Int, 2012) using logistic regression analyses with adjustment for potential confounding factors.

Results

At baseline, the prescribed medicines varied between 0 and 17, and the median (interquartile range) was 5 (3–7). Among 3,968 CKD patients, 1,540 (38.8 %) patients showed polypharmacy. The multivariable-adjusted odds ratios for polypharmacy were 1.42 [95% confidence interval, 0.77–2.61] for G2, 1.44 [0.78–2.65] for G3a, 2.44 [1.34–4.49] for G3b, 4.00 [2.17–7.37] for G4 and 8.64 [4.53–16.5] for G5, respectively, compared with patients in the lowest category (G1) as the reference value. In the higher glomerular filtration rate (GFR) category (>G3b), many drugs, including angiotensin-2 receptor blockers, calcium channel blockers, uric acid synthesis inhibitors, proton pump inhibitors, aspirins, loop diuretics, and cation exchange resins were prescribed more frequently than the lower GFR category (≦G3a). In addition, aldosterone blockers, biguanides, fibrates, non-steroidal anti-inflammatory drugs, and sulfonylureas were continuously prescribed despite decreased GFR.

Conclusion

The higher GFR categories were independently associated with higher odds of polypharmacy. This might reflect the increasing prescription for managing to control symptoms caused by decreased GFR. We also have to pay more attention to prescribe medicines according to renal function.