Polypharmacy, chronic kidney disease, and mortality among older adults: A prospective study of National Health and nutrition examination survey, 1999–2018

Frontiers in Public Health

Public Health

Yonghua Hu¹  Jie Jiang¹  Yuantao Hao²  Xiaowen Wang³  Jia-Yi Dong⁴  Chao Yang⁵ 

[1] Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China;Peking University Center for Public Health and Epidemic Preparedness and Response, Peking University, Beijing, China;Peking University Center for Public Health and Epidemic Preparedness and Response, Peking University, Beijing, China;Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine, Osaka, Japan;Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine, Osaka, Japan;Renal Division, Department of Medicine, Peking University First Hospital, Peking University Institute of Nephrology, Beijing, China;

关键词: NHANES;    chronic kidney disease;    mortality;    elderly;    cohort;    polypharmacy;   

DOI  :  10.3389/fpubh.2023.1116583

 received in 2022-12-05, accepted in 2023-03-08,  发布年份 2023

来源: Frontiers

【 摘 要 】

IntroductionPolypharmacy might contribute to a range of adverse outcomes, which could get worse in the elderly with chronic kidney disease (CKD). Evidence on polypharmacy, CKD, and mortality is scarce. We aimed to investigate the prospective association between polypharmacy, CKD and all-cause and cause-specific mortality in adults aged ≥65 years.MethodsA total of 13,513 adults from the National Health and Nutrition Examination Surveys were included, following up from 1999 to 2018 until December 31, 2019. The simultaneous use of ≥5 medications by one individual was defined as polypharmacy. Survey-weighted Cox proportional hazard models were used to estimate the hazard ratio (HRs) for mortality from all-cause, cardiovascular diseases (CVD), and cancer after adjusting for potential confounding factors.ResultsAmong the elderly with CKD, we identified 3,825 total deaths (1,325 CVD and 714 cancer) during a median follow-up of 7.7 years. Participants with polypharmacy had a 27% (HR = 1.27 [1.15, 1.39]) and 39% (HR = 1.39 [1.19, 1.62]) higher risk of all-cause and CVD mortality, respectively, but not for cancer mortality. Compared with the elderly with no polypharmacy and no CKD, the corresponding HRs (95%CIs) for all-cause mortality were 1.04 (0.96, 1.14) for those with no polypharmacy but CKD, 1.24 (1.11, 1.39) for with polypharmacy but no CKD, and 1.34 (1.21, 1.49) for those with both polypharmacy and CKD. A similar pattern was detected for CVD mortality.DiscussionPolypharmacy was associated with elevated risks of all-cause and CVD mortality among the elderly CKD patients. More evidence-based approaches should be promoted for the appropriate deprescribing in the older adults with CKD.

【 授权许可】

Unknown   
Copyright © 2023 Wang, Yang, Jiang, Hu, Hao and Dong.