Abstract
Background and hypothesis.
Advancing age and chronic kidney disease (CKD) are risk factors for polypharmacy. Polypharmacy is associated with negative healthcare outcomes. Deprescribing, the systematic rationalisation of potentially inappropriate medications, is a proposed way of addressing polypharmacy. The aim of this study was to describe longitudinal prescribing patterns of oral medications in a cohort of older people with advanced CKD in their last years of life.
Methods.
The EQUAL study is a European, prospective cohort study of people ≥65 years with an
incident estimated glomerular filtration rate (eGFR) of ≤20ml/min/1.73m. We analysed a
decedent sub-cohort, using generalized additive models to explore trends in the number and
types of prescribed oral medications over the years preceding death.
Results.
Data from 563 participants were analysed (comprising 2,793 study visits) with a median
follow-up time 2.2 years (interquartile range 1.1-3.8) pre-death. Participants’ numbers of
prescribed oral medications increased steadily over the years approaching death – 7.3 (95%
confidence interval 6.9-7.7) 5 years pre-death, and 8.7 (95% confidence interval 8.4-9.0) at
death. Over the years pre-death, the proportion of people prescribed i) proton-pump
inhibitors and opiates increased; ii) statins, calcium-channel blockers and renin-angiotensin aldosterone system inhibitors decreased; whilst iii) beta-blockers, diuretics and
gabapentinoids remained stable. At their final visits pre-death 14.6% and 5.1% were prescribed opiates and gabapentinoids respectively.
Conclusion.
Elderly people with advanced CKD experienced persistent and increasing levels of
polypharmacy as they approached the end of life. There was evidence of cessation of certain
classes of medications, but at a population level this was outweighed by new prescriptions.
This work highlights the potential for improved medication review in this setting to reduce
the risks associated with polypharmacy. Future work should focus at the individual patient clinician level to better understand the decision making process underlying the observed
prescribing patterns.
Advancing age and chronic kidney disease (CKD) are risk factors for polypharmacy. Polypharmacy is associated with negative healthcare outcomes. Deprescribing, the systematic rationalisation of potentially inappropriate medications, is a proposed way of addressing polypharmacy. The aim of this study was to describe longitudinal prescribing patterns of oral medications in a cohort of older people with advanced CKD in their last years of life.
Methods.
The EQUAL study is a European, prospective cohort study of people ≥65 years with an
incident estimated glomerular filtration rate (eGFR) of ≤20ml/min/1.73m. We analysed a
decedent sub-cohort, using generalized additive models to explore trends in the number and
types of prescribed oral medications over the years preceding death.
Results.
Data from 563 participants were analysed (comprising 2,793 study visits) with a median
follow-up time 2.2 years (interquartile range 1.1-3.8) pre-death. Participants’ numbers of
prescribed oral medications increased steadily over the years approaching death – 7.3 (95%
confidence interval 6.9-7.7) 5 years pre-death, and 8.7 (95% confidence interval 8.4-9.0) at
death. Over the years pre-death, the proportion of people prescribed i) proton-pump
inhibitors and opiates increased; ii) statins, calcium-channel blockers and renin-angiotensin aldosterone system inhibitors decreased; whilst iii) beta-blockers, diuretics and
gabapentinoids remained stable. At their final visits pre-death 14.6% and 5.1% were prescribed opiates and gabapentinoids respectively.
Conclusion.
Elderly people with advanced CKD experienced persistent and increasing levels of
polypharmacy as they approached the end of life. There was evidence of cessation of certain
classes of medications, but at a population level this was outweighed by new prescriptions.
This work highlights the potential for improved medication review in this setting to reduce
the risks associated with polypharmacy. Future work should focus at the individual patient clinician level to better understand the decision making process underlying the observed
prescribing patterns.
| Original language | English |
|---|---|
| Journal | Clinical Kidney Journal |
| Publication status | Accepted/In press - 12 Aug 2024 |