Medication Burden and Regimen Complexity among Dialysis Patients from 2003 to 2024

Patients on dialysis have high medication burden with average of 16 medications per day, 87% major polypharmacy rate and medication complexity index of 35. Medication burden has increased over the past 2 decades in patients receiving maintenance dialysis. Medication burden is primarily driven by cardiovascular, mineral and bone disorder, and diabetes medications.

Medication burden is a significant clinical issue for patients receiving maintenance dialysis. Studies characterizing medication burden are often limited to a single time point. We investigated the change in medication burden for patients over a 22-year period at a large national not-for-profit dialysis organization.

Patients ≥18 years of age receiving maintenance hemodialysis or peritoneal dialysis as of October 1 of each year between 2003 and 2024 were included. Medication burden was characterized as number of active medications on profile, polypharmacy prevalence (≥10 medications), number of pills/capsules per day, and medication regimen complexity index. Medications were classified into therapeutic categories. Patients' demographic, clinical characteristics, and medication burden were summarized overall and each year during the study period and were stratified by modality. Trend analyses for longitudinal medication burden measures were performed using generalized linear models with generalized estimating equations for repeated measures.

Among 82,549 distinct patients (hemodialysis, 72,412 [88%]; peritoneal dialysis, 10,137 [12%] at dialysis initiation), the mean age was 62±15 years, and 44% were female. For per patient-day, the number of medication increased from 13.4 to 15.9 (mean yearly rate of increase, 0.23; 95% confidence limit [CL], 0.22 to 0.24); pill burden increased from 18.1 to 18.6 (mean, 0.16; 95% CL, 0.15 to 0.17); and medication regimen complexity index increased from 29.3 to 35.0 (mean, 0.54; 95% CL, 0.53 to 0.56). Polypharmacy was initially present in 77% of patients and increased to 87% (yearly increase in odds of using ten or more medications per day, 5.1%; 95% CL, 4.9 to 5.4). Treatments for mineral and metabolic bone disease and cardiovascular disease contributed most to medication burden.

Medication burden increased over the past 2 decades in patients receiving maintenance dialysis.