International prescribing patterns and polypharmacy in older people with advanced chronic kidney disease: results from the European Quality study
International prescribing patterns and polypharmacy in older people with advanced chronic kidney disease: results from the European Quality study
BACKGROUND: People with chronic kidney disease (CKD) are at high risk of polypharmacy. However, no previous study has investigated international prescribing patterns in this group. This article aims to examine prescribing and polypharmacy patterns among older people with advanced CKD across the countries involved in the European Quality (EQUAL) study.
METHODS: The EQUAL study is an international prospective cohort study of patients ≥65 years of age with advanced CKD. Baseline demographic, clinical and medication data were analysed and reported descriptively. Polypharmacy was defined as ≥5 medications and hyperpolypharmacy as ≥10. Univariable and multivariable linear regressions were used to determine associations between country and the number of prescribed medications. Univariable and multivariable logistic regression were used to determine associations between country and hyperpolypharmacy.
RESULTS: Of the 1317 participants from five European countries, 91% were experiencing polypharmacy and 43% were experiencing hyperpolypharmacy. Cardiovascular medications were the most prescribed medications (mean 3.5 per person). There were international differences in prescribing, with significantly greater hyperpolypharmacy in Germany {odds ratio (OR) 2.75 [95% confidence interval (CI) 1.73-4.37]; P < 0.001, reference group UK}, the Netherlands [OR 1.91 (95% CI 1.32-2.76); P = 0.001] and Italy [OR 1.57 (95% CI 1.15-2.15); P = 0.004]. People in Poland experienced the least hyperpolypharmacy [OR 0.39 (95% CI 0.17-0.87); P = 0.021].
CONCLUSIONS: Hyperpolypharmacy is common among older people with advanced CKD, with significant international differences in the number of medications prescribed. Practice variation may represent a lack of consensus regarding appropriate prescribing for this high-risk group for whom pharmacological treatment has great potential for harm as well as benefit.
Hayward, S.
05d4e254-af09-4f0c-8f09-15a4ca781194
Hole, B.
be254820-f4cb-4082-81c9-5c9f0ad7fa66
Denholm, R.
d3f8ecf5-4bcd-4b1e-ab45-3f492a23464f
Duncan, P.
be5c1420-87c0-4c86-aeb6-7c6d3393f9ac
Morris, J.E.
631cdf2c-3ddf-41ef-8b74-65a1dffb1e58
Fraser, S.D.S.
135884b6-8737-4e8a-a98c-5d803ac7a2dc
Payne, R.A.
7942b13c-a1a6-4f55-8ce5-37c875a8ec33
Roderick, P.
dbb3cd11-4c51-4844-982b-0eb30ad5085a
Chesnaye, N.C.
882b246c-a9b5-49c0-8467-a1b46a48a9a7
Wanner, C.
22bef052-2f34-402c-9348-1f9f4ca6f8c7
Drechsler, C.
ef9c8890-3ab3-49f9-86ad-b8a8feedc023
Postorino, M.
ae17b79d-ed8c-489f-949b-244e124372f0
Porto, G.
108b4e60-bfc2-4371-b206-bf9403caf1fb
Szymczak, M.
b97aca1e-ee01-47be-a674-3d7269554652
Evans, M.
0f6f0051-a1c3-47d2-9533-566c6a542e8e
Dekker, F.W.
5ff96c12-5e48-427d-a2ba-c2223d1a4fe6
Jager, K.J.
c03856d6-b43d-4b77-b235-56e48c9c868f
Caskey, F.J.
5f576f0a-f2da-473d-82fe-a2b684b9fb29
Hayward, S.
05d4e254-af09-4f0c-8f09-15a4ca781194
Hole, B.
be254820-f4cb-4082-81c9-5c9f0ad7fa66
Denholm, R.
d3f8ecf5-4bcd-4b1e-ab45-3f492a23464f
Duncan, P.
be5c1420-87c0-4c86-aeb6-7c6d3393f9ac
Morris, J.E.
631cdf2c-3ddf-41ef-8b74-65a1dffb1e58
Fraser, S.D.S.
135884b6-8737-4e8a-a98c-5d803ac7a2dc
Payne, R.A.
7942b13c-a1a6-4f55-8ce5-37c875a8ec33
Roderick, P.
dbb3cd11-4c51-4844-982b-0eb30ad5085a
Chesnaye, N.C.
882b246c-a9b5-49c0-8467-a1b46a48a9a7
Wanner, C.
22bef052-2f34-402c-9348-1f9f4ca6f8c7
Drechsler, C.
ef9c8890-3ab3-49f9-86ad-b8a8feedc023
Postorino, M.
ae17b79d-ed8c-489f-949b-244e124372f0
Porto, G.
108b4e60-bfc2-4371-b206-bf9403caf1fb
Szymczak, M.
b97aca1e-ee01-47be-a674-3d7269554652
Evans, M.
0f6f0051-a1c3-47d2-9533-566c6a542e8e
Dekker, F.W.
5ff96c12-5e48-427d-a2ba-c2223d1a4fe6
Jager, K.J.
c03856d6-b43d-4b77-b235-56e48c9c868f
Caskey, F.J.
5f576f0a-f2da-473d-82fe-a2b684b9fb29
Hayward, S., Hole, B., Denholm, R., Duncan, P., Morris, J.E., Fraser, S.D.S., Payne, R.A., Roderick, P., Chesnaye, N.C., Wanner, C., Drechsler, C., Postorino, M., Porto, G., Szymczak, M., Evans, M., Dekker, F.W., Jager, K.J. and Caskey, F.J.
(2020)
International prescribing patterns and polypharmacy in older people with advanced chronic kidney disease: results from the European Quality study.
Nephrology, Dialysis, Transplantation, [gfaa064].
(doi:10.1093/ndt/gfaa064).
Abstract
BACKGROUND: People with chronic kidney disease (CKD) are at high risk of polypharmacy. However, no previous study has investigated international prescribing patterns in this group. This article aims to examine prescribing and polypharmacy patterns among older people with advanced CKD across the countries involved in the European Quality (EQUAL) study.
METHODS: The EQUAL study is an international prospective cohort study of patients ≥65 years of age with advanced CKD. Baseline demographic, clinical and medication data were analysed and reported descriptively. Polypharmacy was defined as ≥5 medications and hyperpolypharmacy as ≥10. Univariable and multivariable linear regressions were used to determine associations between country and the number of prescribed medications. Univariable and multivariable logistic regression were used to determine associations between country and hyperpolypharmacy.
RESULTS: Of the 1317 participants from five European countries, 91% were experiencing polypharmacy and 43% were experiencing hyperpolypharmacy. Cardiovascular medications were the most prescribed medications (mean 3.5 per person). There were international differences in prescribing, with significantly greater hyperpolypharmacy in Germany {odds ratio (OR) 2.75 [95% confidence interval (CI) 1.73-4.37]; P < 0.001, reference group UK}, the Netherlands [OR 1.91 (95% CI 1.32-2.76); P = 0.001] and Italy [OR 1.57 (95% CI 1.15-2.15); P = 0.004]. People in Poland experienced the least hyperpolypharmacy [OR 0.39 (95% CI 0.17-0.87); P = 0.021].
CONCLUSIONS: Hyperpolypharmacy is common among older people with advanced CKD, with significant international differences in the number of medications prescribed. Practice variation may represent a lack of consensus regarding appropriate prescribing for this high-risk group for whom pharmacological treatment has great potential for harm as well as benefit.
Text
EQUAL polypharmacy accepted version of paper
- Accepted Manuscript
More information
Accepted/In Press date: 21 January 2020
e-pub ahead of print date: 16 June 2020
Additional Information:
© The Author(s) 2020. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.
Identifiers
Local EPrints ID: 437913
URI: http://eprints.soton.ac.uk/id/eprint/437913
ISSN: 0931-0509
PURE UUID: 34f75816-f6f7-4207-929d-a4a703fef210
Catalogue record
Date deposited: 24 Feb 2020 17:30
Last modified: 17 Mar 2024 05:19
Export record
Altmetrics
Contributors
Author:
S. Hayward
Author:
B. Hole
Author:
R. Denholm
Author:
P. Duncan
Author:
J.E. Morris
Author:
R.A. Payne
Author:
N.C. Chesnaye
Author:
C. Wanner
Author:
C. Drechsler
Author:
M. Postorino
Author:
G. Porto
Author:
M. Szymczak
Author:
M. Evans
Author:
F.W. Dekker
Author:
K.J. Jager
Author:
F.J. Caskey
Download statistics
Downloads from ePrints over the past year. Other digital versions may also be available to download e.g. from the publisher's website.
View more statistics
