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International prescribing patterns and polypharmacy in older people with advanced chronic kidney disease: results from the EQUAL Study

International prescribing patterns and polypharmacy in older people with advanced chronic kidney disease: results from the EQUAL Study
International prescribing patterns and polypharmacy in older people with advanced chronic kidney disease: results from the EQUAL 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.
0931-0509
Hayward, S.
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Hole, B.
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Denholm, R.
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Duncan, P.
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Morris, J.E.
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Fraser, S.D.S.
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Payne, R.A.
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Roderick, P.
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Chesnaye, N.C.
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Wanner, C.
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Drechsler, C.
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Postorino, M.
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Porto, G.
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Szymczak, M.
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Evans, M.
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Dekker, F.W.
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Jager, K.J.
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Caskey, F.J.
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Hayward, S.
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Hole, B.
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Denholm, R.
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Duncan, P.
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Morris, J.E.
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Fraser, S.D.S.
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Payne, R.A.
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Roderick, P.
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Chesnaye, N.C.
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Wanner, C.
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Drechsler, C.
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Postorino, M.
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Porto, G.
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Szymczak, M.
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Evans, M.
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Dekker, F.W.
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Jager, K.J.
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Caskey, F.J.
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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 EQUAL Study. Nephrology, Dialysis, Transplantation, [gfaa064]. (doi:10.1093/ndt/gfaa064).

Record type: Article

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.

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EQUAL polypharmacy accepted version of paper - Accepted Manuscript
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Accepted/In Press date: 21 January 2020
e-pub ahead of print date: 16 June 2020

Identifiers

Local EPrints ID: 437913
URI: http://eprints.soton.ac.uk/id/eprint/437913
ISSN: 0931-0509
PURE UUID: 34f75816-f6f7-4207-929d-a4a703fef210
ORCID for S.D.S. Fraser: ORCID iD orcid.org/0000-0002-4172-4406
ORCID for P. Roderick: ORCID iD orcid.org/0000-0001-9475-6850

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Date deposited: 24 Feb 2020 17:30
Last modified: 18 Feb 2021 17:11

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Contributors

Author: S. Hayward
Author: B. Hole
Author: R. Denholm
Author: P. Duncan
Author: J.E. Morris
Author: S.D.S. Fraser ORCID iD
Author: R.A. Payne
Author: P. Roderick ORCID iD
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

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