Kidney Week

Abstract: TH-PO939

Polypharmacy and Potentially Inappropriate Medications among Elderly Patients with Advanced Stage G5 CKD

Session Information

• Geriatric Nephrology: Innovations and Insights
  October 24, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Geriatric Nephrology

• 1300 Geriatric Nephrology

Authors

• Yazawa, Masahiko, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan

Masahiko Yazawa, MD, PhD

• Nishiwaki, Hiroki, Showa Daigaku Fujigaoka Byoin, Yokohama, Kanagawa, Japan

Hiroki Nishiwaki, MD, PhD, MPH

• Murakami, Minoru, Saku General Hospital, Saku, Nagano, Japan

Minoru Murakami, MD, MPH

• Saka, Yosuke, Kasugai Shimin Byoin, Kasugai, Aichi, Japan

Yosuke Saka, MD, PhD

• Koitabashi, Kenichiro, Inagi Shiritsu Byoin, Inagi, Tokyo, Japan

Kenichiro Koitabashi, MD, PhD

• Furusho, Masahide, Kagoshima Medical Center, Kagoshima, Kagoshima, Japan

Masahide Furusho, MD, MBA

• Raita, Yoshihiko, Okinawa Chubu Hospital, Naha, Okinawa, Japan

Yoshihiko Raita, MD, MPH

• Kawarazaki, Hiroo, Teikyo University Hospital, Mizonokuchi, Kawasaki, Kanagawa, Japan

Hiroo Kawarazaki, MD, PhD

• Shimizu, Hideaki, Daido Byoin, Nagoya, Aichi, Japan

Hideaki Shimizu, MD, PhD

• Hasegawa, Takeshi, Showa Daigaku, Shinagawa-ku, Tokyo, Japan

Takeshi Hasegawa, MD, PhD, MPH

• Shibagaki, Yugo, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan

Yugo Shibagaki, MD

• Sasaki, Sho, Kyoto Daigaku Igakubu Fuzoku Byoin, Kyoto, Kyoto, Japan

Sho Sasaki, MD, DrPH

Group or Team Name

• Japanese InvestigatOrs with Innovative NeTwork about Kidney Disease (JOINT-KD).

Background

The American Geriatrics Society identifies Beers Criteria and potentially inappropriate medications as medication use–related issues among the elderly. Patients with chronic kidney disease (CKD) experience polypharmacy when managing multiple conditions according to clinical practice guidelines. However, a standardized description of polypharmacy and Beers Criteria–listed medications (BCLM) among elderly patients with non-dialysis-dependent CKD stage G5, defined as an estimated glomerular filtration rate (eGFR) < 15 mL/min/1.73 m², is lacking.

Methods

This multicenter cross-sectional study of eight teaching hospitals in Japan included elderly (≥65 years old) and non-elderly patients with non-dialysis-dependent CKD stage G5. Study candidates were enrolled from April to June 2013, and their total daily number of regular oral medications was recorded. Super-polypharmacy was defined as ≥10 medications. Medication issues, including BCLM, were compared between groups. A multivariable logistic regression analysis was done to analyze factors related to super-pharmacy and BCLM use.

Results

Of the 600 participants, 412 were elderly. The mean age and eGFR of the elderly group were 76.8±7.0 years and 10.8 mL/min/1.73 m², respectively. Total medications were significantly higher in the elderly versus non-elderly group (9.2±3.8 and 8.4±3.6, respectively; p=0.001). Super-polypharmacy was more prevalent in the elderly versus non-elderly group (47% vs. 37%, respectively; p=0.042). Regarding BCLM, fewer elderly participants used insulin and potassium-sparing agents, whereas significantly more elderly participants took proton pump inhibitors and hypnotics. The logistic regression analysis revealed that age, welfare public assistance, hypertension, cardiovascular disease, and diabetes were significantly associated with super-polypharmacy. The BCLM analysis identified age as negatively associated with BCLM use.

Conclusion

Almost half of elderly patients with non-dialysis-dependent CKD stage G5 had super-polypharmacy. Age was significantly associated with polypharmacy but less associated with BCLM use. Although this vulnerable population requires many medications, nephrologists might pay attention to using PIMs.