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Kidney Week

Abstract: SA-PO292

Prevalence of Polypharmacy and Associated Adverse Outcomes in Kidney Transplant Recipients

Session Information

Category: Pharmacology (PharmacoKinetics, -Dynamics, -Genomics)

  • 2000 Pharmacology (PharmacoKinetics, -Dynamics, -Genomics)

Authors

  • Koo, Tai yeon, Korea University Anam Hospital, Seoul, Korea (the Republic of)
  • Kim, Sungyeon, Korea University Anam Hospital, Seoul, Korea (the Republic of)
  • Jang, Yookyung, Korea University Anam Hospital, Seoul, Korea (the Republic of)
  • Jo, Sang-Kyung, Korea University Anam Hospital, Seoul, Korea (the Republic of)
Background

Polypharmacy (PP) continues to increase, and is associated with numerous adverse clinical outcomes and mortality. Although the burden of medication in kidney transplant recipients (KTRs) is well-known, PP has not been characterized in detail in the KTRs. The aim of this study was to assess the prevalence of PP among KTRs and the association between PP and clinical outcomes in the KTRs.

Methods

A total of 972 KTRs from a prospective multicenter observational cohort study in Korea (KNOW-KT; The KoreaN cohort study for Outcome in patients With Kidney Transplantation) between 2012 and 2016 were included in the study. We investigated the association between the number of prescribed medications and adverse outcomes such as graft failure, all-cause mortality and cardiovascular events. PP was defined as the use of more than 10 medications per day at 1 year after kidney transplantation.

Results

The patients with PP were noted in 478 (49.2%) patients. The PP prevalence at 1, 2, 3, 5, and 8 years after transplantation was 49.2%, 36.5%, 35.7%, 36.3% and 24.6%, respectively. The prevalence of diabetes, dyslipidemia and history of cardiovascular disease was significantly higher in the PP group than in the non-PP group (the use of fewer than 10 medications; n= 494). The mean follow-up period was 6.9 years, and there were 69 graft failures, 63 new-onset cardiovascular diseases, and 36 deaths. When the effect of PP prescribed at 1-year post-transplant on clinical outcomes was analyzed, there was no difference in glomerular filtration rate between the non-PP and PP groups, and the hazard ratio of graft failure and death in the PP group was 1.07 (0.718 to 1.59) and 1.37 (0.71 to 2.64), respectively, compared to the non-PP group. However, multivariate analysis adjusted for classical risk factors showed that PP and medication counts independently increased the risk of new cardiovascular disease (adjusted HR 1.76 (1.051-2.950); p=0.032, adjusted HR 1.079 (1.00-1.164, p= 0.049), respectively) after KT.

Conclusion

These results showed that PP is common in KTRs, and considering the adverse effects of PP on KT outcomes, physician’s attention and efforts are needed to systematically manage and prevent inappropriate PP after KT. Long-term and large-scale research is needed to establish management guidelines for PP in the future.