Original Research
Monday, November 13, 2023
01:00 PM–02:30 PM
Abstract
Introduction: Exposure to potentially inappropriately prescribed medications (PIPM), medications supratherapeutically dosed or contraindicated based on renal dosing criteria, is unknown among patients on hemodialysis.
Research Question or Hypothesis: What is the prevalence of exposure to PIPM among patients receiving hemodialysis and what characteristics are associated with exposure?
Study Design: This was a retrospective longitudinal cohort analysis of patients in the United States Renal Disease System database. Patients included if they were >65 years of age, receiving hemodialysis in 2018, enrolled in Medicare Part D for 12 months, and had =1 medication at the start of hemodialysis.
Methods: Counts and percentages described exposure to PIPM at the start of hemodialysis and quarterly up to a year. Logistic regression evaluated associations of characteristics (age, sex, race, Hispanic ethnicity, rurality, social deprivation index (SDI), United States region, polypharmacy, and diagnosis of diabetes and hypertension) with exposure to =1 PIPM at the start of hemodialysis.
Results: There were 33,882 patients included and 29.6% were exposed to PIPM at the start of hemodialysis. After one year, 21.8% were still exposed. Medications most identified as PIPM were gabapentin (5.2%), hydrochlorothiazide (4.6%), famotidine (3.6%), glimepiride (3.4%), rosuvastatin (2.6%), fenofibrate (2.4%), metformin (1.8%), and sitagliptin (1.8%). Patients receiving =4 medications vs. 0-3 were at 2-11 times the odds of being exposed to PIPM (p<0.001). Additional characteristics associated with exposure to PIPM were age =85 vs. <75 years (aOR 0.89, 95%CI 0.82-0.97 p=0.01), being Black/African vs. White (aOR 0.83 95%CI 0.77-0.88, p<0.001), living in a rural vs. urban county (aOR, 1.09 95%CI 1.01-1.17, p=0.02), living in the South vs. Northeast (aOR 1.22 95%CI 1.14-1.31, p<0.001), and diagnosis of diabetes (aOR 1.33, 95%CI 1.26-1.40, p<0.001).
Conclusion: This study found approximately 20-30% of patients on hemodialysis were exposed to PIPM during the observation period. The results from this study can be utilized to develop medication monitoring programs to reduce PIPM exposure.
Presenting Author
Armando Silva Almodóvar PharmDThe Ohio State University College of Pharmacy
Authors
Milap C. Nahata PharmD, MS
The Ohio State University College of Pharmacy
Macarius Donneyong MPH PhD
Ohio State University College of Pharmacy
Eric Seiber PhD
College of Public Health Ohio State University