Medication Exposure and Health Outcomes in Older Patients with End-Stage Kidney Disease: A Prospective Study Undertaken in New Zealand.
Sashika Samaranayaka, Robert J Walker, Ari Samaranayaka, Sarah Derrett, John W B Schollum
Author Information
Sashika Samaranayaka: Department of Medicine, Dunedin School of Medicine, University of Otago, PO Box 56, Dunedin, New Zealand.
Robert J Walker: Department of Medicine, Dunedin School of Medicine, University of Otago, PO Box 56, Dunedin, New Zealand. rob.walker@otago.ac.nz. ORCID
Ari Samaranayaka: Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.
Sarah Derrett: Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.
John W B Schollum: Department of Medicine, Dunedin School of Medicine, University of Otago, PO Box 56, Dunedin, New Zealand.
BACKGROUND: The impact of multiple medication exposure on health outcomes among older patients with end-stage kidney disease (ESKD) is unknown. OBJECTIVE: The objective of this study was to identify the impact of medicine exposure on hospitalisation rates and mortality in a prospective longitudinal observational study of older dialysis patients. METHODS: Patient demographics, medication use, hospitalisation, mortality and co-morbidity data were collected through the prospective longitudinal cohort study DOS65 + (Dialysis Outcomes in those aged ≥ 65 years Study) (n = 225). Medication exposure was measured by the total number of individual medications and the number of predetermined 'medication groups'. Associations between medications prescribed at recruitment and health outcomes as measured by hospitalisation and mortality were assessed by univariate and multivariable regression analyses. RESULTS: Older ESKD patients were exposed to a median of ten (0-20) medications and eight (0-15) medication groups. Multivariate analyses estimate each additional medication increased mortality risk by 8% (relative risk [RR] = 1.08; 95% confidence interval [CI] 1.07-1.09); each medication group increased mortality risk by 11% (RR = 1.11; 95% CI 1.09-1.12). Similar trends were observed for hospitalisation. Certain medication groups were associated with reduced hospitalisation rates, namely angiotensin converting enzyme (ACE) inhibitors/angiotensin receptor blockers (RR = 0.62; 95% CI 0.53-0.72) and dihydropyridines (RR = 0.64; 95% CI 0.54-0.76). Warfarin, gastric acid suppressants, diuretics and β-blockers were associated with increased hospitalisation rates. Warfarin was associated with an increased mortality rate (RR = 1.40; 95% CI 1.19-1.65). CONCLUSIONS: Multiple medication exposure was prevalent in this older ESKD population, and was associated with an increased risk of mortality and hospitalisation. While this study is not able to determine the cause of these relationships, review of medication use is warranted in this population. TRIAL REGISTRATION: ACTRN12611000024943.
Associated Data
ANZCTR | ACTRN12611000024943
References
Am J Kidney Dis. 2004 Nov;44(5 Suppl 2):7-15
[PMID: 15486868]
Am J Kidney Dis. 2004 Nov;44(5 Suppl 2):61-7
[PMID: 15486876]
