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Nagano N, Zushida C, Tagahara A, Miya M, Tamei N, Muto S, Tsutsui T, Ando T, Ogawa T, Ito K. Association between phosphate binder pill burden and mortality risk in patients on maintenance hemodialysis: a single-center cohort study with 7-year follow-up of 513 patients. Clin Exp Nephrol 2023; 27:961-971. [PMID: 37578637 DOI: 10.1007/s10157-023-02388-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 07/21/2023] [Indexed: 08/15/2023]
Abstract
BACKGROUND Dialysis patients often take multiple oral medications, leading to a high pill burden. Phosphate binders (PBs) account for a large proportion of this daily pill burden (DPB). The relationship between DPB and mortality risk remains unclear, and we hypothesized that this relationship might be influenced by the proportion of PBs to all medications. METHODS We divided DPB into those derived from PBs and non-PB drugs and analyzed the association with mortality risk over a 7-year period in 513 chronic hemodialysis patients using a baseline model. RESULTS The median (interquartile range) DPB from all drugs was 15.8 (11.2-21.0) pills/day/patient, and the median ratio of PB pills to all drug pills was 29.3 (13.7-45.9)% at baseline. During a median observation period of 5.2 years, 161 patients (31.4%) died. Kaplan-Meier analysis showed no significant difference in all-cause mortality between PB users and non-users. However, a significant survival advantage was observed in the highest tertile of DPB from PBs compared to the lowest tertile. Conversely, the highest tertile of DPB from non-PB drugs was associated with worse survival. Consequently, the highest tertile of the ratio of PBs to all pills was associated with better survival. This association remained significant even after adjusting for patient characteristics in the Cox proportional hazards model. However, when serum nutritional parameters were included as covariates, the significant association disappeared. CONCLUSIONS Dialysis patients prescribed a higher rate of PB pills to all medications exhibited a lower mortality risk, possibly due to their better nutritional status.
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Affiliation(s)
- Nobuo Nagano
- Kidney Disease and Dialysis Center, Hidaka Hospital, Hidaka-kai, Takasaki, Gunma, Japan.
- Department of Medicine, Adachi Medical Center, Tokyo Women's Medical University, Tokyo, Japan.
| | - Chie Zushida
- Kidney Disease and Dialysis Center, Hidaka Hospital, Hidaka-kai, Takasaki, Gunma, Japan
| | - Ayaka Tagahara
- Kidney Disease and Dialysis Center, Hidaka Hospital, Hidaka-kai, Takasaki, Gunma, Japan
| | - Masaaki Miya
- Kidney Disease and Dialysis Center, Hidaka Hospital, Hidaka-kai, Takasaki, Gunma, Japan
| | - Noriko Tamei
- Kidney Disease and Dialysis Center, Hidaka Hospital, Hidaka-kai, Takasaki, Gunma, Japan
| | - Shigeaki Muto
- Kidney Disease and Dialysis Center, Hidaka Hospital, Hidaka-kai, Takasaki, Gunma, Japan
| | - Takaaki Tsutsui
- Kidney Disease and Dialysis Center, Hidaka Hospital, Hidaka-kai, Takasaki, Gunma, Japan
| | - Tetsuo Ando
- Kidney Disease and Dialysis Center, Hidaka Hospital, Hidaka-kai, Takasaki, Gunma, Japan
| | - Tetsuya Ogawa
- Kidney Disease and Dialysis Center, Hidaka Hospital, Hidaka-kai, Takasaki, Gunma, Japan
- Department of Medicine, Adachi Medical Center, Tokyo Women's Medical University, Tokyo, Japan
| | - Kyoko Ito
- Kidney Disease and Dialysis Center, Hidaka Hospital, Hidaka-kai, Takasaki, Gunma, Japan
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Nagano N, Fukushima T, Shikata R, Ando T, Tsutsui T, Ogawa T, Ito K. Impact of phosphate binders on medication dosing frequency, timing, and number of prescribed pills in hemodialysis patients. Ther Apher Dial 2022; 26:1174-1181. [PMID: 35138029 DOI: 10.1111/1744-9987.13813] [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: 12/02/2021] [Revised: 02/01/2022] [Accepted: 02/06/2022] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Phosphate binders (PBs) account for a large proportion of the daily pill burden in hemodialysis patients. However, patients do not take them all at once but at several dosing timings. METHODS We analyzed the dosing timings of all 322 types of oral drugs prescribed to 533 hemodialysis patients. RESULTS The median daily dosing frequency for all drugs was 6 (4-7) times/day/patient. Patients prescribed PBs had a markedly higher daily dosing frequency than those not taking PBs [7 (5-8) times /day/patient versus 4 (3-5) times/day/patient, respectively (P<0.001)]. In addition, the ratio of the number of PB pills to other drugs varied greatly at each dosing timing. Furthermore, it was simulated that the daily dosing frequency could be reduced by approximately two times/day/patient by combining the dosing timings of PBs. CONCLUSION Changing PB dosing timings can reduce the daily dosing frequency, which may lead to improved medication adherence.
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Affiliation(s)
- Nobuo Nagano
- Kidney Disease and Dialysis Center, Hidaka Hospital, Hidaka-kai, Takasaki, Gunma, Japan.,Department of Medicine, Tokyo Women's Medical University Medical Center East, Tokyo, Japan
| | - Takahiro Fukushima
- Kidney Disease and Dialysis Center, Hidaka Hospital, Hidaka-kai, Takasaki, Gunma, Japan
| | - Risa Shikata
- Kidney Disease and Dialysis Center, Hidaka Hospital, Hidaka-kai, Takasaki, Gunma, Japan
| | - Tetsuo Ando
- Kidney Disease and Dialysis Center, Hidaka Hospital, Hidaka-kai, Takasaki, Gunma, Japan
| | - Takaaki Tsutsui
- Kidney Disease and Dialysis Center, Hidaka Hospital, Hidaka-kai, Takasaki, Gunma, Japan
| | - Tetsuya Ogawa
- Kidney Disease and Dialysis Center, Hidaka Hospital, Hidaka-kai, Takasaki, Gunma, Japan.,Department of Medicine, Tokyo Women's Medical University Medical Center East, Tokyo, Japan
| | - Kyoko Ito
- Kidney Disease and Dialysis Center, Hidaka Hospital, Hidaka-kai, Takasaki, Gunma, Japan
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Nagano N, Ito K, Ono T, Ariyoshi Y, Masima S, Kobayashi H, Ando T, Tsutsui T, Ogawa T. Prescription characteristics of phosphate binders in a high pill burden for hemodialysis patients. RENAL REPLACEMENT THERAPY 2021. [DOI: 10.1186/s41100-021-00322-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Dialysis patients have to take many oral drugs, causing a high pill burden. Phosphate binders (PBs) account for a large proportion of daily pill burden; however, the relationship between patient background and prescription status of PBs is not clear.
Methods
We clarified the characteristics of PBs in the total daily pill burden by analyzing the drugs prescribed for 533 chronic hemodialysis patients in our facility.
Results
An average of nine different types of oral drugs was prescribed for each patient. The mean and median values of total pill burden were 15.1 and 14.1 pills/day/patient, respectively. The total pill burden showed a significant negative correlation with age and a significant positive correlation with dialysis vintage. In addition, the total pill burden was significantly higher in males than in females. However, there was no difference in the pill burden between patients with and without diabetes mellitus (DM). PBs were prescribed to 409 patients (76.7%), and the mean pill burden derived from PBs was 6.44 pills/day/patient. This was by far the highest of all 35 different drug categories and accounted for 32.84% of all pills. Multiple regression analysis demonstrated that independent predictors of total pill burden were age, dialysis vintage, DM, and serum phosphorus (P) levels, and all these variables, except DM, were also independent predictors of pill burden from PBs. These variables were also selected when considering the use of calcimimetics.
Conclusions
A high pill burden is more likely to occur in younger patients with longer dialysis vintage, DM, higher serum P levels, and prescription of calcimimetics. In addition, PB was the single largest contributor to the total pill burden that positively and linearly linked to serum P levels. Therefore, P management is a high-priority issue in the mitigation of high pill burdens in dialysis patients.
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