Association of Polypharmacy with Kidney Disease Progression in Adults with CKD

Area of Science:

• Nephrology
• Clinical Pharmacology
• Epidemiology

Background:

• Polypharmacy is prevalent in chronic kidney disease (CKD) patients and linked to adverse outcomes.
• The specific impact of polypharmacy on kidney outcomes in CKD requires further elucidation.

Purpose of the Study:

• To investigate the association between the number of prescribed medications and adverse outcomes, including kidney failure, cardiovascular events, and all-cause mortality.
• To explore the risk of kidney failure requiring kidney replacement therapy (KRT) in relation to polypharmacy among patients with nondialysis-dependent CKD.

Main Methods:

• Retrospective cohort study of 1117 Japanese patients with nondialysis-dependent CKD from the Fukushima CKD Cohort Study.
• Polypharmacy defined as 5-9 medications daily; hyperpolypharmacy as ≥10 medications daily.
• Outcomes assessed included kidney failure, cardiovascular events, and all-cause mortality over a median follow-up of 4.8 years.

Main Results:

• The median number of medications was eight, with 38% prevalence for both polypharmacy and hyperpolypharmacy.
• Compared to <5 medications, polypharmacy (5-9 meds) and hyperpolypharmacy (≥10 meds) were associated with significantly higher adjusted hazard ratios for kidney failure (2.28 and 2.83, respectively).
• High medication use was also linked to increased risk of cardiovascular events and all-cause mortality.

Conclusions:

• High medication use, including polypharmacy and hyperpolypharmacy, is associated with an elevated risk of kidney failure in Japanese patients with nondialysis-dependent CKD.
• The findings underscore the significant association between polypharmacy and adverse kidney and overall health outcomes in CKD patients.
• Careful medication management is crucial for patients with CKD to mitigate risks.