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Oosting IJ, Colombijn JM, Kaasenbrood L, Liabeuf S, Laville SM, Hooft L, Bots ML, Verhaar MC, Vernooij RW. Polypharmacy in Patients with CKD: A Systematic Review and Meta-Analysis. KIDNEY360 2024; 5:841-850. [PMID: 38661553 PMCID: PMC11219116 DOI: 10.34067/kid.0000000000000447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 04/12/2024] [Indexed: 04/26/2024]
Abstract
Key Points The prevalence of polypharmacy in patients with CKD was over 80%. Polypharmacy was highest in patients with a kidney transplant and those receiving dialysis. Polypharmacy is associated with worse clinical outcomes, lower quality of life, and medication-related problems in patients with CKD. Background Despite the high prevalence of polypharmacy in patients with CKD, the extent of polypharmacy across patients with (different stages of) CKD, as well as the association with clinical outcomes remains unknown. This systematic review aimed to evaluate the prevalence of polypharmacy in (different subgroups of) patients with CKD and assess the association between polypharmacy and patient-important outcomes. Methods MEDLINE, Embase, and the Cochrane Library were searched from inception until July 2022. Studies that reported the prevalence of polypharmacy, medication use, or pill burden in patients with CKD (including patients receiving dialysis and kidney transplant recipients) and their association with patient-important outcomes (i.e ., mortality, kidney failure, quality of life [QoL], and medication nonadherence) were included. Two reviewers independently screened title and abstract and full texts, extracted data, and assessed risk of bias. Data were pooled in a random-effects single-arm meta-analysis. Results In total, 127 studies were included (CKD 3–5 n =39, dialysis: n =38, kidney transplant n =13, different CKD stages n =37). The pooled prevalence of polypharmacy, based on 63 studies with 484,915 patients, across all patients with CKD was 82% (95% confidence interval, 76% to 86%), and the pooled mean number of prescribed medications was 9.7 (95% confidence interval, 8.4 to 11.0). The prevalence of polypharmacy was higher in patients who received dialysis or a kidney transplant compared with patients with CKD 3–5 but did not differ between studies with regards to region or patients' mean age or sex. In patients with CKD, polypharmacy was associated with a higher risk of all-cause mortality, kidney failure, faster eGFR decline, lower QoL, and higher medication nonadherence, adverse drug reactions, and potentially inappropriate medications. Conclusions The prevalence of polypharmacy in patients with CKD was over 80%, and highest in patients with a kidney transplant and those receiving dialysis. No causes of heterogeneity were identified, indicating that polypharmacy is an issue for all patients with CKD. Polypharmacy is associated with worse clinical outcomes, lower QoL, and medication-related problems in patients with CKD. Clinical Trial registry name and registration number: PROSPERO (CRD42022331941).
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Affiliation(s)
- Ilse J. Oosting
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Julia M.T. Colombijn
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Lotte Kaasenbrood
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Sophie Liabeuf
- MP3CV Laboratory, EA7517, Jules Verne University of Picardie, Amiens, France
- Pharmacoepidemiology Unit, Department of Clinical Pharmacology, Amiens University Medical Center, Amiens, France
| | - Solène M. Laville
- MP3CV Laboratory, EA7517, Jules Verne University of Picardie, Amiens, France
- Pharmacoepidemiology Unit, Department of Clinical Pharmacology, Amiens University Medical Center, Amiens, France
| | - Lotty Hooft
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Cochrane Netherlands, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Michiel L. Bots
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Marianne C. Verhaar
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Robin W.M. Vernooij
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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Carollo M, Crisafulli S, Vitturi G, Besco M, Hinek D, Sartorio A, Tanara V, Spadacini G, Selleri M, Zanconato V, Fava C, Minuz P, Zamboni M, Trifirò G. Clinical impact of medication review and deprescribing in older inpatients: A systematic review and meta-analysis. J Am Geriatr Soc 2024. [PMID: 38822740 DOI: 10.1111/jgs.19035] [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: 02/17/2024] [Revised: 04/25/2024] [Accepted: 05/13/2024] [Indexed: 06/03/2024]
Abstract
BACKGROUND Polypharmacy is a primary risk factor for the prescription of potentially inappropriate medications (PIMs), drug-drug interactions (DDIs), and ultimately, adverse drug reactions (ADRs). Medication review and deprescribing represent effective strategies to simplify therapeutic regimens, minimize risks, and reduce PIM prescriptions. This systematic review and meta-analysis of experimental and observational studies aimed to evaluate the impact of different medication review and deprescribing interventions in hospitalized older patients. METHODS Experimental and observational prospective cohort studies evaluating the clinical effects of medication review and deprescribing strategies in older hospitalized patients were searched in the bibliographic databases, PubMed, Embase, and Scopus, from inception until January 8, 2024. A narrative synthesis of the results was provided, along with a meta-analysis of dichotomous data (i.e., re-hospitalizations and mortality). RESULTS Overall, 21 randomized controlled trials, 7 non-randomized interventional studies, and 2 prospective cohort studies were included in the systematic review. Of these, 14 (46.7%) assessed medication appropriateness as the primary outcome, while the remaining evaluated clinical outcomes (e.g., length of hospital stay, hospital readmissions, emergency department visits, and incidence of ADRs) and/or quality of life. The meta-analysis revealed a slight but statistically significant 8% reduction in hospital readmissions (HR: 0.92; 95% CI: 0.85-0.99) following medication review and deprescribing, but no significant impact on mortality (HR: 0.98; 95% CI: 0.96-1.00). Of the 30 included studies, 21 were considered at high risk of bias, mostly due to potential deviations from intended interventions and randomization processes. The remaining nine studies had "some concerns" (eight studies) or were considered at "low" risk of bias (one study). CONCLUSION Medication review and deprescribing are associated with potential benefits in reducing hospital readmission rates among hospitalized older patients, particularly through the reduction of PIM prescriptions. The integration of thorough medication review and deprescribing protocols in hospital settings may improve post-discharge outcomes and reduce overall healthcare costs.
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Affiliation(s)
- Massimo Carollo
- Department of Diagnostics and Public Health, Clinical Pharmacology Unit, University of Verona, Verona, Italy
| | | | - Giacomo Vitturi
- Department of Diagnostics and Public Health, Clinical Pharmacology Unit, University of Verona, Verona, Italy
| | - Matilde Besco
- Department of Medicine, Geriatrics Division, University of Verona, Verona, Italy
| | - Damiano Hinek
- Department of Pharmacy, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Andrea Sartorio
- Department of Medicine, Section of Internal Medicine C, University of Verona, Verona, Italy
| | - Valentina Tanara
- Department of Pharmacy, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Giulia Spadacini
- Department of Medicine, Geriatrics Division, University of Verona, Verona, Italy
| | - Margherita Selleri
- Department of Diagnostics and Public Health, Clinical Pharmacology Unit, University of Verona, Verona, Italy
| | - Valentina Zanconato
- Department of Medicine, Section of Internal Medicine C, University of Verona, Verona, Italy
| | - Cristiano Fava
- Department of Medicine, Section of Internal Medicine C, University of Verona, Verona, Italy
| | - Pietro Minuz
- Department of Medicine, Section of Internal Medicine C, University of Verona, Verona, Italy
| | - Mauro Zamboni
- Department of Surgery, Dentistry, Pediatric and Gynecology, Section of Geriatric Medicine, University of Verona, Verona, Italy
| | - Gianluca Trifirò
- Department of Diagnostics and Public Health, Clinical Pharmacology Unit, University of Verona, Verona, Italy
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Vijayan M, Mohottige D. Deprescribing in Dialysis: Operationalizing "Less is More" Through a Multimodal Deprescribing Intervention. Kidney Med 2024; 6:100819. [PMID: 38689837 PMCID: PMC11059387 DOI: 10.1016/j.xkme.2024.100819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024] Open
Affiliation(s)
- Madhusudan Vijayan
- Barbara T. Murphy Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Dinushika Mohottige
- Barbara T. Murphy Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
- Institute for Health Equity Research, Department of Population Health, Icahn School of Medicine at Mount Sinai, New York, NY
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Danjuma MI, Alkaabi L, Sayed R, Naseralallah L. Association of polypharmacy with incidence of CKD: a retrospective cohort study: a letter to the Editor. Clin Exp Nephrol 2024; 28:470-471. [PMID: 38112981 DOI: 10.1007/s10157-023-02443-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 11/29/2023] [Indexed: 12/21/2023]
Affiliation(s)
- M I Danjuma
- Department of Internal Medicine, Hamad Medical Corporation, Doha, Qatar.
- Department of Internal Medicine, Weill Cornell College of Medicine, New York and Doha, Qatar.
- Department of Internal Medicine, Qatar University College of Medicine, Doha, Qatar.
- NHS Grampian (Dr Grays Hospital), Elgin, Scotland, UK.
| | - L Alkaabi
- Department of Internal Medicine, Qatar University College of Medicine, Doha, Qatar
| | - R Sayed
- Department of Internal Medicine, Qatar University College of Medicine, Doha, Qatar
| | - L Naseralallah
- Division of Clinical Pharmacy, Hamad Medical Corporation, Doha, Qatar
- School of Pharmacy, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
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Danjuma MI, Sayed R, Elzouki I. Commentary: Potentially inappropriate medication among older patients with diabetic kidney disease. Front Pharmacol 2023; 14:1210331. [PMID: 37456738 PMCID: PMC10338866 DOI: 10.3389/fphar.2023.1210331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 06/12/2023] [Indexed: 07/18/2023] Open
Affiliation(s)
- M. I. Danjuma
- Department of Internal Medicine, Hamad Medical Corporation, Doha, Qatar
- Department of Internal Medicine, Weill Cornell College of Medicine, New York, NY, United States
- Department of Internal Medicine, Weill Cornell College of Medicine, Doha, Qatar
- Department of Internal Medicine, Qatar University College of Medicine, Doha, Qatar
- NHS Grampian (Dr. Grays Hospital), Elgin, United Kingdom
| | - R. Sayed
- Department of Internal Medicine, Qatar University College of Medicine, Doha, Qatar
| | - I. Elzouki
- Department of Internal Medicine, Hamad Medical Corporation, Doha, Qatar
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