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Kidney Week

Abstract: PO2281

Polypharmacy and Potentially Inappropriate Medication Use in Patients with CKD Managed in Canadian Primary Care

Session Information

Category: CKD (Non-Dialysis)

  • 2101 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention

Authors

  • Tinwala, Mohammed M., University of Alberta Faculty of Medicine & Dentistry, Edmonton, Alberta, Canada
  • Zaidi, Deenaz, University of Alberta Faculty of Medicine & Dentistry, Edmonton, Alberta, Canada
  • Ye, Feng, University of Alberta Faculty of Medicine & Dentistry, Edmonton, Alberta, Canada
  • Muneer, Shezel, University of Alberta Faculty of Medicine & Dentistry, Edmonton, Alberta, Canada
  • Ghimire, Anukul, University of Alberta Faculty of Medicine & Dentistry, Edmonton, Alberta, Canada
  • Khan, Maryam, University of Alberta Faculty of Medicine & Dentistry, Edmonton, Alberta, Canada
  • Sultana, Naima, University of Alberta Faculty of Medicine & Dentistry, Edmonton, Alberta, Canada
  • Okpechi, Ikechi G., University of Alberta Faculty of Medicine & Dentistry, Edmonton, Alberta, Canada
  • Ronksley, Paul E., University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
  • Drummond, Neil, University of Alberta Faculty of Medicine & Dentistry, Edmonton, Alberta, Canada
  • Mangin, Dee, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
  • Bello, Aminu K., University of Alberta Faculty of Medicine & Dentistry, Edmonton, Alberta, Canada
Background

Polypharmacy and the use of potentially inappropriate medications (PIMs) are an increasingly serious public health challenge attributable to aging populations and multimorbidity. This study assessed the prevalence of polypharmacy and use of PIMs in chronic kidney disease (CKD).

Methods

A cross-sectional analysis using the Canadian Primary Care Sentinel Surveillance Network (CPCSSN) database (January 1, 2010 through December 31, 2018). Polypharmacy was defined as the use of ≥ 5 medications, excessive polypharmacy as ≥ 10 medications, and PIMs as medications recommended to be avoided in CKD.

Results

The cohort was comprised of 70,331 patients (mean [SD] age, 73.1 [11.4] years; 40,502 [57.6%] female) with CKD stages G3a to G5. The most common chronic conditions were hypertension (60.8%), diabetes (29.4%), and osteoarthritis (25.4%). Overall, the prevalence of polypharmacy and excessive polypharmacy was 91.5% and 74.9%, respectively. The median number of medications was 14 (IQR 9-23). The most commonly prescribed medications were atorvastatin (29.8%), amlodipine (28.9%), and rosuvastatin (27.2%). About 45% of patients with CKD had at least one PIM, 11.1% had two PIMs, and 3.6 % had three or more PIMs. The most commonly prescribed PIMs were metformin (21.7%), nitrofurantoin (16.2%), and rivaroxaban (4.5%).

Conclusion

Polypharmacy and use of PIMs are highly prevalent among patients with CKD managed in primary care. These findings highlight opportunities for interventions aimed at improving prescribing practices in the management of CKD.

Funding

  • Government Support – Non-U.S.