BACKGROUND
Despite the high prevalence of polypharmacy in patients with chronic kidney disease (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, and medication non-adherence) 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 [CI]: 76-86%) and the pooled mean number of prescribed medications 9.7 (95%CI: 8.4-11.0). The prevalence of polypharmacy was higher in patients who received dialysis or a kidney transplant compared to 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 quality of life (QoL), and higher medication non-adherence, 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.

Polypharmacy in Patients with Chronic Kidney Disease.

Background Diabetic nephropathy is a serious complication of diabetes that significantly increases the risk of chronic kidney disease (CKD) and end-stage renal disease (ESRD). A critical concern in managing patients with diabetic nephropathy is the prevalence of potentially inappropriate medications (PIMs), which can exacerbate kidney dysfunction and lead to adverse health outcomes. PIMs are defined as medications whose risks outweigh their benefits, particularly when safer alternatives are available. The exact prevalence of the potentially inappropriate fraction of this as well as factors associated with the prescription of these medications remains variable. This study seeks to investigate the prevalence of PIMs in a diabetic population with CKD, aiming to identify the factors that contribute to this issue. Methods We conducted a cross-sectional study analyzing clinical and electronic data from patients with diabetic nephropathy who were receiving care in the wards and outpatient clinics of Hamad Medical Corporation. Data were extracted from medical records, encompassing demographic information, comorbidities, prescribed medications, and kidney function, measured as estimated glomerular filtration rate (eGFR). The American Geriatrics Society Beers Criteria was employed to identify PIMs in older adults. Statistical analyses included chi-square tests for categorical variables and logistic regression to identify factors associated with PIM prescriptions. Results Of the 860 patients analyzed, 248 (28.8%) were prescribed at least one PIM. The most commonly prescribed classes of PIMs were sulfonylureas and nonsteroidal anti-inflammatory drugs (NSAIDs). Significant factors associated with PIM prescriptions included older age (OR 1.52, 95% CI 1.21-1.92), lower eGFR (OR 1.67, 95% CI 1.28-2.19), and polypharmacy (OR 1.83, 95% CI 1.42-2.36). Conclusion In this examination of the combined inpatient and outpatient database of patients with diabetic nephropathy, we identified a high prevalence of PIMs, particularly in individuals of older age, those with lower eGFR, and those experiencing polypharmacy. The findings underscore the importance of addressing polypharmacy through targeted therapeutic interventions aimed at reducing the use of PIMs in this population. By implementing such strategies, we can enhance medication safety and improve overall health outcomes for patients with diabetic nephropathy. 

The Prevalence of Potentially Inappropriate Medications Among Patients With Diabetic Nephropathy: A Cross-Sectional Study Conducted at a Tertiary Care Hospital

Pos-314 polypharmacy and potentially inappropriate medication use in patients with ckd managed in canadian primary care

Pos-315 prevalence of polypharmacy and associated adverse health outcomes in patients with ckd: a systematic review and meta-analysis

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Pos-314 polypharmacy and potentially inappropriate medication use in patients with ckd managed in canadian primary care

Pos-315 prevalence of polypharmacy and associated adverse health outcomes in patients with ckd: a systematic review and meta-analysis