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Abstract: PO0839

Medication Burden and Prescribing Patterns Among ESKD Patients on Hemodialysis in the United States, 2013-2017

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Paik, Julie M., Brigham and Women's Hospital, Boston, Massachusetts, United States
  • Zhuo, Min, Brigham and Women's Hospital, Boston, Massachusetts, United States
  • Kim, Seoyoung C., Brigham and Women's Hospital, Boston, Massachusetts, United States
  • Desai, Rishi J., Brigham and Women's Hospital, Boston, Massachusetts, United States
Background

The medication burden of patients with ESKD on HD is amongst the highest of any of the chronic diseases. This study describes the medication burden and prescribing patterns in a contemporary cohort of patients with ESKD on HD in the U.S.

Methods

We used the United States Renal Data System database from January 1, 2013 and December 31, 2017 to quantify the medication burden of patients on HD aged ≥18 years. We included patients who had continuous Medicare parts A, B, and D coverage for at least 3 months prior to January 1 of the respective year and excluded patients with a history of peritoneal dialysis or kidney transplant at any time prior to the year of interest. Patients could contribute data to multiple yearly cohorts. We calculated the average number of prescription medications per patient during each respective year, number of medications within classes, including potentially harmful medications, and trends in the number of medications and classes over the study period.

Results

We included 163,228 to 176,133 patients from 2013 to 2017. In 2013, the mean age was 63.5 years and increased to 65.1 years by 2017. The percentage in the age 18-64 years category decreased (51.3% in 2013 compared with 45.9% in 2017) and the percentage in the older age categories all increased. In 2013, 51.8% were male and 48.2% were female, compared with 53.6% male and 46.4% female in 2017. The overall burden of medications decreased slightly, from a mean of 7.4 (SD 3.8) in 2013 to 6.8 (SD 3.6) medications in 2017. Prescribing of potentially harmful medications decreased over time (74.0% with at least one harmful medication class in 2013 to 68.5% in 2017). In particular, the prescribing of non-benzodiazepine hypnotics, benzodiazepines, and opioids decreased from 2013 to 2017 (12.2% to 6.3%, 23.4% to 19.3%, and 60.0% to 53.4%, respectively). This trend was consistent across subgroups of age, sex, race, and low-income subsidy status.

Conclusion

Patients with ESKD on HD continued to have a high overall medication burden, with a slight reduction over time accompanied by a decrease in prescribing of several classes of harmful medications. Continued emphasis on assessment of appropriateness of high medication burden in patients with ESKD is needed to avoid exposure to potentially harmful or futile medications in this vulnerable patient population.