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Atić A, Matijašević Škerlj J, Jurić I, Katalinić L, Furić Čunko V, Kljajić M, Sabljić Z, Jelaković B, Bašić-Jukić N. Factors Associated with Hyperpolypharmacy and Complex Medication Regimens in Kidney Transplant Recipients. J Clin Med 2024; 13:3716. [PMID: 38999282 PMCID: PMC11242636 DOI: 10.3390/jcm13133716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2024] [Revised: 06/23/2024] [Accepted: 06/24/2024] [Indexed: 07/14/2024] Open
Abstract
Background: Kidney transplantation is considered the best modality for renal replacement therapy. The use of immunosuppressive therapy and pre-existing and newly developed comorbidities predispose these patients to the use of a large number of medications. (Hyper)polypharmacy is associated with worse adherence and negative outcomes. This study aims to explore the factors correlated with hyperpolypharmacy and complex medication regimens in kidney transplant recipients. Methods: This is a cross-sectional study of outpatient kidney transplant recipients. Collected data include demographic data, complete chronic medication lists, medical history, and graft function. Linear and logistic regression were used to identify factors associated with hyperpolypharmacy and complex medication regimens. Medication regimen complexity was quantified by the Medication Regimen Complexity Index (MRCI). Results: Overall, 224 kidney transplant recipients were included, with an average time since transplantation of 8 years. Hyperpolypharmacy was present in more than two-thirds of patients; the average number of different medications was 12; and the mean MRCI score was 21.4, ranging from 6 to 50. Hypertension was almost universally present, while other frequently prescribed medication groups were hypolipemics, medication for bone-mineral metabolism disorders, gout, and antihyperglycemics. Conclusions: Factors independently associated with hyperpolypharmacy and complex medication regimens were found to be age and graft function. Studies investigating interventions aimed at reducing medication complexity and increasing adherence should focus on older patients with worse graft function.
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Affiliation(s)
- Armin Atić
- Division of Nephrology, Arterial Hypertension, Dialysis and Transplantation, University Hospital Center Zagreb, Kispaticeva 12, 10000 Zagreb, Croatia
| | | | - Ivana Jurić
- Division of Nephrology, Arterial Hypertension, Dialysis and Transplantation, University Hospital Center Zagreb, Kispaticeva 12, 10000 Zagreb, Croatia
| | - Lea Katalinić
- Division of Nephrology, Arterial Hypertension, Dialysis and Transplantation, University Hospital Center Zagreb, Kispaticeva 12, 10000 Zagreb, Croatia
| | - Vesna Furić Čunko
- Division of Nephrology, Arterial Hypertension, Dialysis and Transplantation, University Hospital Center Zagreb, Kispaticeva 12, 10000 Zagreb, Croatia
| | - Marina Kljajić
- Division of Nephrology, Arterial Hypertension, Dialysis and Transplantation, University Hospital Center Zagreb, Kispaticeva 12, 10000 Zagreb, Croatia
| | - Zoran Sabljić
- Division of Nephrology, Arterial Hypertension, Dialysis and Transplantation, University Hospital Center Zagreb, Kispaticeva 12, 10000 Zagreb, Croatia
| | - Bojan Jelaković
- Division of Nephrology, Arterial Hypertension, Dialysis and Transplantation, University Hospital Center Zagreb, Kispaticeva 12, 10000 Zagreb, Croatia
| | - Nikolina Bašić-Jukić
- Division of Nephrology, Arterial Hypertension, Dialysis and Transplantation, University Hospital Center Zagreb, Kispaticeva 12, 10000 Zagreb, Croatia
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Kiberd J, Quinn RR, Ravani P, Lentine KL, Clarke A, Jeong R, Faruque L, Lam NN. Proton Pump Inhibitors Use in Kidney Transplant Recipients: A Population-Based Study. Can J Kidney Health Dis 2024; 11:20543581241228723. [PMID: 38356921 PMCID: PMC10865938 DOI: 10.1177/20543581241228723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 12/12/2023] [Indexed: 02/16/2024] Open
Abstract
Background Kidney transplant recipients are commonly prescribed proton-pump inhibitors (PPIs), but due to concern for polypharmacy, chronic use should be limited. Objective The objective was to describe PPI use in kidney transplant recipients beyond their first year of transplant to better inform and support deprescribing initiatives. Design We conducted a retrospective, population-based cohort study using linked health care databases. Setting This study was conducted in Alberta, Canada. Patients We included all prevalent adult, kidney-only transplant recipients between April 2008 and December 2017 who received their transplant between May 2002 and December 2017. Measurements The primary outcome was ongoing or new PPI use and patterns of use, including frequency and duration of therapy, and assessment of indication for PPI use. Methods We ascertained baseline characteristics, covariate information, and outcome data from the Alberta Kidney Disease Network (AKDN). We compared recipients with evidence of a PPI prescription in the 3 months prior to study entry to those with a histamine-2-receptor antagonist (H2Ra) fill and those with neither. Results We identified 1823 kidney transplant recipients, of whom 868 (48%) were on a PPI, 215 (12%) were on an H2Ra, and 740 (41%) were on neither at baseline. Over a median follow-up of 5.4 years (interquartile range [IQR] = 2.6-9.3), there were almost 45 000 unique PPI prescriptions dispensed, the majority (80%) of which were filled by initial PPI users. Recipients who were on a PPI at baseline would spend 91% (IQR = 70-98) of their graft survival time on a PPI in follow-up, and nephrologists were the main prescribers. We identified an indication for ongoing PPI use in 54% of recipients with the most common indication being concurrent antiplatelet use (26%). Limitations Our kidney transplant recipients have access to universal health care coverage which may limit generalizability. We identified common gastrointestinal indications for PPI use but did not include rare conditions due to concerns about the validity of diagnostic codes. In addition, symptoms suggestive of reflux may not be well coded as the focus of follow-up visits is more likely to focus on kidney transplant. Conclusions Many kidney transplant recipients are prescribed a PPI at, or beyond, the 1-year post-transplant date and are likely to stay on a PPI in follow-up. Almost half of the recipients in our study did not have an identifiable indication for ongoing PPI use. Nephrologists frequently prescribe PPIs to kidney transplant recipients and should be involved in deprescribing initiatives to reduce polypharmacy.
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Affiliation(s)
- James Kiberd
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Robert R. Quinn
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Pietro Ravani
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | | | - Alix Clarke
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Rachel Jeong
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Labib Faruque
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Ngan N. Lam
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
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Brady A, Misra S, Abdelmalek M, Kekic A, Kunze K, Lim E, Jakob N, Mour G, Keddis MT. The Value of Pharmacogenomics for White and Indigenous Americans after Kidney Transplantation. PHARMACY 2023; 11:125. [PMID: 37624080 PMCID: PMC10457738 DOI: 10.3390/pharmacy11040125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 08/03/2023] [Accepted: 08/05/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND There is a paucity of evidence to inform the value of pharmacogenomic (PGx) results in patients after kidney transplant and how these results differ between Indigenous Americans and Whites. This study aims to identify the frequency of recommended medication changes based on PGx results and compare the pharmacogenomic (PGx) results and patients' perceptions of the findings between a cohort of Indigenous American and White kidney transplant recipients. METHODS Thirty-one Indigenous Americans and fifty White kidney transplant recipients were studied prospectively. Genetic variants were identified using the OneOme RightMed PGx test of 27 genes. PGx pharmacist generated a report of the genetic variation and recommended changes. Pre- and post-qualitative patient surveys were obtained. RESULTS White and Indigenous American subjects had a similar mean number of medications at the time of PGx testing (mean 13 (SD 4.5)). In the entire cohort, 53% received beta blockers, 30% received antidepressants, 16% anticoagulation, 47% pain medication, and 25% statin therapy. Drug-gene interactions that warranted a clinical action were present in 21.5% of patients. In 12.7%, monitoring was recommended. Compared to the Whites, the Indigenous American patients had more normal CYP2C19 (p = 0.012) and CYP2D6 (p = 0.012) activities. The Indigenous American patients had more normal CYP4F2 (p = 0.004) and lower VKORC (p = 0.041) activities, phenotypes for warfarin drug dosing, and efficacy compared to the Whites. SLC6A4, which affects antidepressant metabolism, showed statistical differences between the two cohorts (p = 0.017); specifically, SLC6A4 had reduced expression in 45% of the Indigenous American patients compared to 20% of the White patients. There was no significant difference in patient perception before and after PGx. CONCLUSIONS Kidney transplant recipients had several drug-gene interactions that were clinically actionable; over one-third of patients were likely to benefit from changes in medications or drug doses based on the PGx results. The Indigenous American patients differed in the expression of drug-metabolizing enzymes and drug transporters from the White patients.
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Affiliation(s)
- Alexandra Brady
- Department of Nephrology and Hypertension, Mayo Clinic, Scottsdale, AZ 85259, USA
| | - Suman Misra
- Department of Nephrology and Hypertension, Mayo Clinic, Scottsdale, AZ 85259, USA
| | - Mina Abdelmalek
- Department of Nephrology and Hypertension, Mayo Clinic, Scottsdale, AZ 85259, USA
| | - Adrijana Kekic
- Department of Pharmacy Clinical Practice, Mayo Clinic, Scottsdale, AZ 85259, USA
| | - Katie Kunze
- Department of Statistics, Mayo Clinic, Scottsdale, AZ 85259, USA
| | - Elisabeth Lim
- Department of Statistics, Mayo Clinic, Scottsdale, AZ 85259, USA
| | - Nicholas Jakob
- Department of Nephrology and Hypertension, Mayo Clinic, Scottsdale, AZ 85259, USA
| | - Girish Mour
- Department of Nephrology and Hypertension, Mayo Clinic, Scottsdale, AZ 85259, USA
| | - Mira T. Keddis
- Department of Nephrology and Hypertension, Mayo Clinic, Scottsdale, AZ 85259, USA
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Alrasheed M, Guo JJ, Lin AC, Wigle PR, Hardee A, Hincapie AL. The effect of polypharmacy on quality of life in adult patients with nonalcoholic fatty liver disease in the United States. Qual Life Res 2022; 31:2481-2491. [DOI: 10.1007/s11136-022-03090-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2022] [Indexed: 02/08/2023]
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van Oosten MJM, Logtenberg SJJ, Hemmelder MH, Leegte MJH, Bilo HJG, Jager KJ, Stel VS. Polypharmacy and medication use in patients with chronic kidney disease with and without kidney replacement therapy compared to matched controls. Clin Kidney J 2021; 14:2497-2523. [PMID: 34950462 PMCID: PMC8690067 DOI: 10.1093/ckj/sfab120] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 04/16/2021] [Accepted: 04/20/2021] [Indexed: 12/12/2022] Open
Abstract
Background This study aims to examine polypharmacy (PP) prevalence in patients with chronic kidney disease (CKD) Stage G4/G5 and patients with kidney replacement therapy (KRT) compared with matched controls from the general population. Furthermore, we examine risk factors for PP and describe the most commonly dispensed medications. Methods Dutch health claims data were used to identify three patient groups: CKD Stage G4/G5, dialysis and kidney transplant patients. Each patient was matched to two controls based on age, sex and socio-economic status (SES) score. We differentiated between ‘all medication use’ and ‘chronic medication use’. PP was defined at three levels: use of ≥5 medications (PP), ≥10 medications [excessive PP (EPP)] and ≥15 medications [hyper PP (HPP)]. Results The PP prevalence for all medication use was 87, 93 and 95% in CKD Stage G4/G5, dialysis and kidney transplant patients, respectively. For chronic medication use, this was 66, 70 and 75%, respectively. PP and comorbidity prevalence were higher in patients than in controls. EPP was 42 times more common in young CKD Stage G4/G5 patients (ages 20–44 years) than in controls, while this ratio was 3.8 in patients ≥75 years. Older age (64–75 and ≥75 years) was a risk factor for PP in CKD Stage G4/G5 and kidney transplant patients. Dialysis patients ≥75 years of age had a lower risk of PP compared with their younger counterparts. Additional risk factors in all patients were low SES, diabetes mellitus, vascular disease, hospitalization and an emergency room visit. The most commonly dispensed medications were proton pump inhibitors (PPIs) and statins. Conclusions CKD Stage G4/G5 patients and patients on KRT have a high medication burden, far beyond that of individuals from the general population, as a result of their kidney disease and a large burden of comorbidities. A critical approach to medication prescription in general, and of specific medications like PPIs and statins (in the dialysis population), could be a first step towards more appropriate medication use.
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Affiliation(s)
- Manon J M van Oosten
- Department of Medical Informatics, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | | | - Marc H Hemmelder
- Division of Nephrology, Department of Internal Medicine, Maastricht University Medical Center, The Netherlands
| | | | - Henk J G Bilo
- Diabetes Research Center and Department of Epidemiology and Statistics, Isala Hospital, Zwolle, The Netherlands
| | - Kitty J Jager
- Department of Medical Informatics, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Vianda S Stel
- Department of Medical Informatics, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
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Afifi MK, Kenawy AS, El Demellawy HH, Azouz AA, Al-Otaibi T, Gheith O, ElMonem MA, AbdElhalim MS, Hussein RRS. Optimization of osteoporosis and osteopenia management among renal transplant recipients. FUTURE JOURNAL OF PHARMACEUTICAL SCIENCES 2021. [DOI: 10.1186/s43094-021-00378-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Osteoporosis and osteopenia occur frequently in renal transplant recipients due to long-term use of immune-suppressants including corticosteroids. Previous treatment options like bisphosphonates had acceptable but rather unsatisfactory results after transplant. The aim of the current study is to directly compare the efficacy of denosumab and oral ibandronate in late RTR with low bone mineral density.
Results
The study was conducted Iin Hamed Al-Essa Kidney transplant center, Kuwait, in 2020. The data of 52 denosumab and 48 ibandronate patients were collected at the baseline and after one year of treatment. Spine and hip T-score readings, side effects, and other laboratory results were analyzed to evaluate the use of both medications. The mean number of months after transplant was 25 (± 13.9) months. After one year of treatment, denosumab alleviated both spinal osteoporosis and osteopenia T-score values from −3.13 to −2.4 (p = 0.008) and from −1.9 to −1.5 (p = 0.015), respectively. Besides, it reduced hip osteoporosis and osteopenia insignificantly from −3.45 to −3.1 and from −1.5 to −1.3, respectively (p > 0.05). Ibandronate improved spinal osteopenia from −1.6 to −1.55 (p = 0.97) and failed to show any positive impact on other sites; the spinal osteoporosis changed from −2.8 to −3 and hip osteoporosis and osteopenia changed from −3.1 to −3.12 and from −1.4 to −1.45, respectively (p > 0.05). The use of ibandronate was more associated with gastrointestinal tract (GIT) side effects, while hypocalcemia episodes were significantly higher in the denosumab group.
Conclusion
Denosumab improved both spinal and hip T-score values in comparison with ibandronate in RTR. Close monitoring is required for denosumab patients to prevent the associated hypocalcemia.
Graphical Abstract
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Colombijn JMT, Bonenkamp AA, van Eck van der Sluijs A, Bijlsma JA, Boonstra AH, Özyilmaz A, Abrahams AC, van Jaarsveld BC. Impact of Polypharmacy on Health-Related Quality of Life in Dialysis Patients. Am J Nephrol 2021; 52:735-744. [PMID: 34518456 DOI: 10.1159/000518454] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 06/24/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Dialysis patients are often prescribed a large number of medications to improve metabolic control and manage coexisting comorbidities. However, some studies suggest that a large number of medications could also detrimentally affect patients' health-related quality of life (HRQoL). Therefore, this study aims to provide insight in the association between the number of types of medications and HRQoL in dialysis patients. METHODS A multicentre cohort study was conducted among dialysis patients from Dutch dialysis centres 3 months after initiation of dialysis as part of the ongoing prospective DOMESTICO study. The number of types of medications, defined as the number of concomitantly prescribed types of drugs, was obtained from electronic patient records. Primary outcome was HRQoL measured with the Physical Component Summary (PCS) score and Mental Component Summary (MCS) score (range 0-100) of the Short Form 12. Secondary outcomes were number of symptoms (range 0-30) measured with the Dialysis Symptoms Index and self-rated health (range 0-100) measured with the EuroQol-5D-5L. Data were analysed using linear regression and adjusted for possible confounders, including comorbidity. Analyses for MCS and number of symptoms were performed after categorizing patients in tertiles according to their number of medications because assumptions of linearity were violated for these outcomes. RESULTS A total of 162 patients were included. Mean age of patients was 58 ± 17 years, 35% were female, and 80% underwent haemodialysis. The mean number of medications was 12.2 ± 4.5. Mean PCS and MCS were 36.6 ± 10.2 and 46.8 ± 10.0, respectively. The mean number of symptoms was 12.3 ± 6.9 and the mean self-rated health 60.1 ± 20.6. In adjusted analyses, PCS was 0.6 point lower for each additional medication (95% confidence interval [95% CI]: -0.9 to -0.2; p = 0.002). MCS was 4.9 point lower (95% CI: -8.8 to -1.0; p = 0.01) and 1.0 point lower (95% CI: -5.1-3.1; p = 0.63) for the highest and middle tertiles of medications, respectively, than for the lowest tertile. Patients in the highest tertile of medications reported 4.1 more symptoms than in the lowest tertile (95% CI: 1.5-6.6; p = 0.002), but no significant difference in the number of symptoms was observed between the middle and lowest tertiles. Self-rated health was 1.5 point lower for each medication (95% CI: -2.2 to -0.7; p < 0.001). DISCUSSION/CONCLUSION After adjustment for comorbidity and other confounders, a higher number of medications were associated with a lower PCS, MCS, and self-rated health in dialysis patients and with more symptoms.
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Affiliation(s)
- Julia M T Colombijn
- Department of Nephrology, Amsterdam UMC, Research Institute Amsterdam Cardiovascular Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands,
| | - Anna A Bonenkamp
- Department of Nephrology, Amsterdam UMC, Research Institute Amsterdam Cardiovascular Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | | | - Joost A Bijlsma
- Department of Nephrology, Amsterdam UMC, Research Institute Amsterdam Cardiovascular Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Dianet Dialysis Centre, Amsterdam, The Netherlands
| | | | - Akin Özyilmaz
- Dialysis Centre Groningen, Groningen, The Netherlands
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, Groningen, The Netherlands
| | - Alferso C Abrahams
- Department of Nephrology and Hypertension, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Brigit C van Jaarsveld
- Department of Nephrology, Amsterdam UMC, Research Institute Amsterdam Cardiovascular Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Diapriva Dialysis Centre, Amsterdam, The Netherlands
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Min HK, Sung SA, Chung W, Kim YH, Chae DW, Ahn C, Oh KH, Park SK, Lee SW. Polypharmacy and the Progression of Chronic Kidney Disease: Korean Cohort Study for Outcome in Patients with Chronic Kidney Disease. Kidney Blood Press Res 2021; 46:460-468. [PMID: 34091449 DOI: 10.1159/000516029] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 03/20/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION The renal hazard of polypharmacy has never been evaluated in predialysis chronic kidney disease (CKD) patients. OBJECTIVE We aimed to analyze the renal hazard of polypharmacy in predialysis CKD patients with stage 1-5. METHOD The data of 2,238 patients from a large-scale multicenter prospective Korean study (2011-2016), excluding 325 patients with various missing data, were reviewed. Polypharmacy was defined as taking 6 or more medications at the time of enrollment; renal events were defined as a ≥50% decrease in kidney function from baseline values, doubling of the serum creatinine levels, or initiation of renal replacement treatment. Hazard ratio (HR) and 95% confidence interval (CI) were calculated using Cox proportional-hazard regression analysis. RESULTS Of the 1,913 patients, the mean estimated glomerular filtration rate was 53.6 mL/min/1.73 m2. The mean medication count was 4.1, and the prevalence of polypharmacy was 27.1%. During the average period of 3.6 years, 520 patients developed renal events (27.2%). Although increased medication counts were associated with increased renal hazard with HR (95% CI) of 1.056 (1.007-1.107, p = 0.025), even after adjusting for various confounders, adding comorbidity score and kidney function nullified the statistical significance. In mediation analysis, 55.6% (p = 0.016) of renal hazard in increased medication counts was mediated by the kidney function, and there was no direct effect of medication counts on renal event development. In subgroup analysis, the renal hazard of the medication counts was evident only in stage 1-3 of CKD patients (p for interaction = 0.014). CONCLUSIONS We cannot identify the direct renal hazard of multiple medications, and most of the potential renal hazard was derived from intimate relationship with disease burden and kidney function.
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Affiliation(s)
- Hyang Ki Min
- Department of Internal Medicine, Nowon Eulji Medical Center, Eulji University, Seoul, Republic of Korea
| | - Su Ah Sung
- Department of Internal Medicine, Nowon Eulji Medical Center, Eulji University, Seoul, Republic of Korea
| | - Wookyung Chung
- Department of Internal Medicine, Gachon University, Gil Hospital, Incheon, Republic of Korea
| | - Yeong Hoon Kim
- Department of Internal Medicine, Inje University, Busan Paik Hospital, Busan, Republic of Korea
| | - Dong-Wan Chae
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.,Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnamsi, Republic of Korea
| | - Curie Ahn
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.,Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Kook-Hwan Oh
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.,Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Sue K Park
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.,Cancer Research Institute, Seoul National University, Seoul, Republic of Korea.,Department of Biomedical Science, Seoul National University Graduate School, Seoul, Republic of Korea
| | - Sung Woo Lee
- Department of Internal Medicine, Uijeongbu Eulji University Medical Center, Uijeongbu, Republic of Korea
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Marienne J, Laville SM, Caillard P, Batteux B, Gras-Champel V, Masmoudi K, Choukroun G, Liabeuf S. Evaluation of Changes Over Time in the Drug Burden and Medication Regimen Complexity in ESRD Patients Before and After Renal Transplantation. Kidney Int Rep 2021; 6:128-137. [PMID: 33426392 PMCID: PMC7785410 DOI: 10.1016/j.ekir.2020.10.011] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 10/07/2020] [Accepted: 10/13/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Medication regimen complexity (MRC) has not been characterized in detail in patients with end-stage renal disease (ESRD). The objective of the present study was to quantify changes over time in the prescription drug burden and MRC in patients with ESRD (before transplantation, on discharge after kidney transplantation [M0], and 4 months [M4] and 12 months [M12] afterward). METHODS We retrospectively studied adult patients having undergone kidney transplantation. The number and types of drug prescribed, the pill burden, and the MRC index (MRCI) at 4 different time points (before transplantation, M0, M4, and M12) were extracted from the patients' medical records. MRCI was calculated by adding each drug score (calculated according to its formulation, dosing frequency, and additional instructions concerning administration). Hence, the MRCI took account of all prescription drugs. A logistic regression model was used to identify factors associated with an elevated MRCI at M12. RESULTS The median (interquartile range) age of the 354 study participants was 52 years (42-62). Respectively 21%, 42%, 53%, and 38% of the patients were taking 10 or more drugs before transplantation and at M0, M4, and M12. At M12, the 3 most frequently prescribed drug classes were immunosuppressants, cardiovascular system drugs, and drugs acting on the alimentary tract and metabolism. The pill burden and MRCI before transplantation were significantly lower (P < 0.001) than at each time point after transplantation. Diabetes and dyslipidemia were independently associated with an elevated MRCI at M12. CONCLUSION In kidney transplant recipients, the drug burden and MRCI were greater at all time points after transplantation than before transplantation. The impact of the drug burden and MRC on medication adherence and clinical outcomes in these patients requires further evaluation.
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Affiliation(s)
- Justine Marienne
- Department of Clinical Pharmacology, Amiens University Hospital, Amiens, France
| | - Solène M. Laville
- Centre for Research in Epidemiology and Population Health (CESP), INSERM UMRS 1018, Villejuif, France
| | - Pauline Caillard
- MP3CV Laboratory, EA7517, University of Picardie Jules Verne, Amiens, Amiens, France
- Department of Nephrology, Amiens University Hospital, Amiens, France
| | - Benjamin Batteux
- Department of Clinical Pharmacology, Amiens University Hospital, Amiens, France
- MP3CV Laboratory, EA7517, University of Picardie Jules Verne, Amiens, Amiens, France
| | - Valérie Gras-Champel
- Department of Clinical Pharmacology, Amiens University Hospital, Amiens, France
- MP3CV Laboratory, EA7517, University of Picardie Jules Verne, Amiens, Amiens, France
| | - Kamel Masmoudi
- Department of Clinical Pharmacology, Amiens University Hospital, Amiens, France
| | - Gabriel Choukroun
- MP3CV Laboratory, EA7517, University of Picardie Jules Verne, Amiens, Amiens, France
- Department of Nephrology, Amiens University Hospital, Amiens, France
| | - Sophie Liabeuf
- Department of Clinical Pharmacology, Amiens University Hospital, Amiens, France
- MP3CV Laboratory, EA7517, University of Picardie Jules Verne, Amiens, Amiens, France
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Jehn U, Schütte-Nütgen K, Strauss M, Kunert J, Pavenstädt H, Thölking G, Suwelack B, Reuter S. Antihypertensive Treatment in Kidney Transplant Recipients-A Current Single Center Experience. J Clin Med 2020; 9:jcm9123969. [PMID: 33297518 PMCID: PMC7762385 DOI: 10.3390/jcm9123969] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 11/20/2020] [Accepted: 12/03/2020] [Indexed: 12/11/2022] Open
Abstract
Arterial hypertension affects the survival of the kidney graft and the cardiovascular morbidity and mortality of the recipient after kidney transplantation (KTx). Thus, antihypertensive treatment is necessary for a vast majority of these patients. Long-term data on antihypertensive drugs and their effects on allograft function after KTx is still limited, and further investigation is required. We retrospectively analyzed a cohort of 854 recipients who received a kidney transplant at our transplant center between 2007 and 2015 with regard to antihypertensive treatment and its influence on graft function and survival. 1-y after KTx, 95.3% patients were treated with antihypertensive therapy. Of these, 38.6% received mono- or dual-drug therapy, 38.0% received three to four drugs and 8.1% were on a regimen of ≥5 drugs. Beta-blockers were the most frequently used antihypertensive agents (68.1%). Neither the use of angiotensin-converting enzyme inhibitor/angiotensin receptor blockers (51.9%) and calcium channel blockers (51.5%), nor the use the use of loop diuretics (38.7%) affected allograft survival. Arterial hypertension and the number of antihypertensive agents were associated with unfavorable allograft outcomes (each p < 0.001). In addition to the well-known risk factors of cold ischemic time and acute rejection episodes, the number of antihypertensive drugs after one year, which reflects the severity of hypertension, is a strong predictor of unfavorable allograft survival.
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Affiliation(s)
- Ulrich Jehn
- Department of Medicine D, Division of General Internal Medicine, Nephrology and Rheumatology, University Hospital of Münster, 48149 Münster, Germany; (U.J.); (K.S.-N.); (J.K.); (H.P.); (G.T.); (B.S.)
| | - Katharina Schütte-Nütgen
- Department of Medicine D, Division of General Internal Medicine, Nephrology and Rheumatology, University Hospital of Münster, 48149 Münster, Germany; (U.J.); (K.S.-N.); (J.K.); (H.P.); (G.T.); (B.S.)
| | - Markus Strauss
- Department of Medicine C, Division of Cardiology and Angiology, University Hospital of Münster, 48149 Münster, Germany;
| | - Jan Kunert
- Department of Medicine D, Division of General Internal Medicine, Nephrology and Rheumatology, University Hospital of Münster, 48149 Münster, Germany; (U.J.); (K.S.-N.); (J.K.); (H.P.); (G.T.); (B.S.)
| | - Hermann Pavenstädt
- Department of Medicine D, Division of General Internal Medicine, Nephrology and Rheumatology, University Hospital of Münster, 48149 Münster, Germany; (U.J.); (K.S.-N.); (J.K.); (H.P.); (G.T.); (B.S.)
| | - Gerold Thölking
- Department of Medicine D, Division of General Internal Medicine, Nephrology and Rheumatology, University Hospital of Münster, 48149 Münster, Germany; (U.J.); (K.S.-N.); (J.K.); (H.P.); (G.T.); (B.S.)
| | - Barbara Suwelack
- Department of Medicine D, Division of General Internal Medicine, Nephrology and Rheumatology, University Hospital of Münster, 48149 Münster, Germany; (U.J.); (K.S.-N.); (J.K.); (H.P.); (G.T.); (B.S.)
| | - Stefan Reuter
- Department of Medicine D, Division of General Internal Medicine, Nephrology and Rheumatology, University Hospital of Münster, 48149 Münster, Germany; (U.J.); (K.S.-N.); (J.K.); (H.P.); (G.T.); (B.S.)
- Correspondence: ; Tel.: +49-251-83-47540; Fax: +49-251-83-56973
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Yamamoto S, Matsuzawa R, Kamitani T, Hoshi K, Ishii D, Noguchi F, Hamazaki N, Nozaki K, Ichikawa T, Maekawa E, Matsunaga A, Yoshida K. Efficacy of Exercise Therapy Initiated in the Early Phase After Kidney Transplantation: A Pilot Study. J Ren Nutr 2020; 30:518-525. [PMID: 32507332 DOI: 10.1053/j.jrn.2019.11.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 10/23/2019] [Accepted: 11/24/2019] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE In patients with kidney transplant (KT), frailty is a predictor of adverse outcomes. Outcomes of exercise therapy in patients with KT, particularly the efficacy of early exercise after KT, have not been evaluated. We investigated the effect of exercise intervention beginning early after KT on physical performance, physical activity, quality of life, and kidney function in patients with KT. METHODS KT recipients who underwent surgery with usual care plus exercise training from a prospective cohort (exercise group; n = 10) and those with usual care alone from a historical cohort (control group; n = 14) were included in this study. Early exercise comprised supervised aerobic training and physical activity instruction from day 6 to 2 months after KT. The following outcomes were measured: 6-minute walking distance, isometric knee extensor strength, gait speed, physical activity, quality of life, and estimated glomerular filtration rate. RESULTS Analyses of covariance, adjusted for baseline values, revealed significant mean differences between exercise and control groups at 2 months after KT in 6-minute walking distance (+44.4 m, P = .03) and isometric knee extensor strength (+8.1%body weight, P = .03). No significant between-group differences were found in gait speed, physical activity, and quality of life. The analysis of variance for comparison of the area under the recovery curves of estimated glomerular filtration rate after KT revealed no significant difference between groups. CONCLUSION Supervised aerobic training and physical activity instruction initiated in the early phase after KT can improve physical performance without adversely affecting kidney function.
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Affiliation(s)
- Shohei Yamamoto
- Department of Rehabilitation Sciences, Kitasato University Graduate School of medical Sciences, Sagamihara, Japan
| | - Ryota Matsuzawa
- Department of Physical Therapy, School of Rehabilitation, Hyogo University of Health Sciences, Kobe, Hyogo, Japan
| | - Tsukasa Kamitani
- Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Keika Hoshi
- Center for Public Health Informatics, National Institute of Public Health, Wako, Japan; Department of Hygiene, Kitasato University School of Medicine, Sagamihara, Japan
| | - Daisuke Ishii
- Department of Urology, Kitasato University School of Medicine, Sagamihara, Japan
| | - Fumino Noguchi
- Department of Transplant Support Center, Kitasato University Hospital, Sagamihara, Japan
| | - Nobuaki Hamazaki
- Department of Rehabilitation, Kitasato University Hospital, Sagamihara, Japan
| | - Kohei Nozaki
- Department of Rehabilitation, Kitasato University Hospital, Sagamihara, Japan
| | - Takafumi Ichikawa
- Department of Rehabilitation, Kitasato University Hospital, Sagamihara, Japan
| | - Emi Maekawa
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan
| | - Atsuhiko Matsunaga
- Department of Rehabilitation Sciences, Kitasato University Graduate School of medical Sciences, Sagamihara, Japan
| | - Kazunari Yoshida
- Department of Organ Transplant Medicine, Kitasato University School of Medicine, Sagamihara, Japan.
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Kleibert KRU, Hermann EF, Nunes PL, Schneider A, Stumm EMF, Colet CDF. Polimedicação em usuários de varfarina sódica do Sistema Único de Saúde e variáveis associadas. REVISTA CIÊNCIAS EM SAÚDE 2020. [DOI: 10.21876/rcshci.v10i2.900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Objetivo: Verificar o uso da polimedicação em usuários de varfarina e sua associação com variáveis clínicas. Métodos: estudo transversal, com usuários de varfarina, de ambos os sexos. Para a coleta dos dados foi utilizado questionário estruturado, com perguntas abertas e fechadas, sobre dados socioeconômicos, clínicos e aspectos relacionados à farmacoterapia (reações adversas, interações medicamentosas, índices de pressão arterial sistêmica, valores de glicemia de jejum, prática de automedicação, sobrepeso, episódios de sangramento e de tromboembolismo). Resultados: a média de idade dos participantes foi de 69,1 ± 13,6 anos, maioria do sexo feminino (64,6%), casado (43,8%), e de etnia branca (85,4%). Quanto a escolaridade, 41,7% cursaram ensino fundamental incompleto. Os pacientes polimedicados totalizaram 89,6%, e os pacientes em uso de dez ou mais medicamentos, 31,3%. A média de medicamentos foi 8,2 ± 3,5 fármacos/paciente. Ocorreu associação entre polimedicação, ocorrência de reações adversas (94,7% vs 5,3%; p = 0,042) e o número de potenciais interações medicamentosas, totais (8,9 ± 5,0 vs 1,2 ± 1,6; p = 0,001) e graves (3,1 ± 2,4 vs 0,4 ± 0,6; p = 0,017). As demais variáveis estudadas não foram associadas com a polimedicação. Conclusão: os resultados demonstraram interferência negativa da polimedicação na ocorrência de reações adversas, e nas potenciais interações medicamentosas totais e graves. Há necessidade de conhecer o impacto destas variáveis no paciente anticoagulado polimedicado para o planejamento de estratégias de redução de riscos e para a otimização dos benefícios.
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Wang H, Du C, Liu H, Zhang S, Wu S, Fu Y, Zhao J. Exploration of symptom experience in kidney transplant recipients based on symptoms experience model. Qual Life Res 2020; 29:1281-1290. [PMID: 31898113 DOI: 10.1007/s11136-019-02404-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/18/2019] [Indexed: 12/19/2022]
Abstract
PURPOSE Kidney transplant recipients suffer from a variety of symptoms, and symptom management is crucial in improving their quality of life (QOL). Accordingly, this study aims to identify the symptoms experienced by kidney transplant recipients and examine the relationship amongst antecedents, symptom experience and QOL of recipients in China. METHODS A total of 300 kidney transplant recipients were investigated in one of the most first-rate hospitals in China by asking them to fill out a self-designed general questionnaire, the Symptom Experience Scale, the Sense of Coherence Scale (Chinese version), the Revised Life Orientation Test (Chinese version) and the 36-item Short Form Health Survey (Chinese version). RESULTS Kidney transplant recipients experienced multiple symptoms that were frequent, severe and bothersome. The final model showed significant consistency with the data. In the QOL model, post-transplant time, complications, immunosuppressive agents and sense of coherence explained 30.7% of the variance of symptom experience. Moreover, habitual residence, economic burden, post-transplant time, kidney function, optimism and symptom experience accounted for 70.6% of the variance on QOL. CONCLUSIONS We can explain the relationship between antecedents, symptom experience and QOL amongst Chinese kidney transplant recipients by using Symptoms Experience Model. Clinicians and caregivers can manage the recipient's symptoms during follow-up from psychological, physical and medication management perspectives. Improving sense of coherence, maintaining optimism and managing symptoms are essential for enhancing QOL.
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Affiliation(s)
- Han Wang
- School of Nursing, Beijing University of Chinese Medicine, Intersection of Yangguang South Street and Baiyang East Road, Fang Shan District, Beijing, 102488, China
| | - Chunyan Du
- School of Nursing, Beijing University of Chinese Medicine, Intersection of Yangguang South Street and Baiyang East Road, Fang Shan District, Beijing, 102488, China
| | - Hongxia Liu
- School of Nursing, Beijing University of Chinese Medicine, Intersection of Yangguang South Street and Baiyang East Road, Fang Shan District, Beijing, 102488, China.
| | - Shuping Zhang
- School of Nursing, Beijing University of Chinese Medicine, Intersection of Yangguang South Street and Baiyang East Road, Fang Shan District, Beijing, 102488, China
| | - Sisi Wu
- School of Nursing, Beijing University of Chinese Medicine, Intersection of Yangguang South Street and Baiyang East Road, Fang Shan District, Beijing, 102488, China
| | - Yingxin Fu
- Organ Transplant Centre, Tianjin First Central Hospital, Tianjin, China
| | - Jie Zhao
- Organ Transplant Centre, Tianjin First Central Hospital, Tianjin, China
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Sirois C, Simard M, Gosselin E, Gagnon ME, Roux B, Laroche ML. Mixed Bag “Polypharmacy”: Methodological Pitfalls and Challenges of This Exposure Definition. CURR EPIDEMIOL REP 2019. [DOI: 10.1007/s40471-019-00214-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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