Hyperpolypharmacy in patients with chronic kidney disease and its impact on clinical outcomes

Area of Science:

• Nephrology
• Clinical Pharmacology
• Public Health

Background:

• Hyperpolypharmacy (≥10 daily medications) is prevalent in chronic kidney disease (CKD) patients but its clinical impact is not well understood.
• CKD patients often manage multiple comorbidities, increasing the likelihood of polypharmacy and hyperpolypharmacy.

Purpose of the Study:

• To describe the drug burden in a large cohort of non-dialyzed CKD outpatients.
• To assess the association between hyperpolypharmacy and adverse outcomes, including adverse drug reactions (ADRs), hospitalizations, kidney replacement therapy (KRT) initiation, and mortality.

Main Methods:

• Prospective observational study of 3,011 CKD outpatients (eGFR <60 mL/min/1.73 m²) from the CKD-REIN cohort over five years.
• Data collected included drug prescriptions, kidney function, ADRs, hospitalizations, KRT initiation, and deaths.
• Statistical analyses, including hazard ratios (HR) with 95% confidence intervals (CI), were used to assess associations.

Main Results:

• At baseline, 33% of CKD patients exhibited hyperpolypharmacy, a rate that remained stable over time.
• Hyperpolypharmacy was significantly associated with an increased likelihood of ADRs (HR 1.21 [1.04-1.40]), hospitalizations (HR 1.34 [1.18-1.51]), and death before KRT (HR 1.46 [1.17-1.82]).
• Among patients with eGFR ≥30 mL/min/1.73 m², hyperpolypharmacy increased the risk of KRT initiation (HR 1.46 [1.00-2.13]), but this association was not observed in patients with eGFR <30 mL/min/1.73 m².

Conclusions:

• Hyperpolypharmacy is a significant concern in the CKD population, contributing to substantial adverse outcomes.
• Regular medication reviews are crucial for CKD patients to mitigate the risks associated with high drug burden.
• Identifying and managing hyperpolypharmacy can improve patient safety and clinical outcomes in chronic kidney disease.