Scientific Poster Session III - Original Research

Original Research
  Monday, November 13, 2023
  01:00 PM–02:30 PM

Abstract

Introduction: Exposure to supratherapeutically dosed or contraindicated medications based on renal dosing criteria, also known as potentially inappropriately prescribed medications (PIPM), is unknown among patients on peritoneal dialysis (PD).

Research Question or Hypothesis: How many patients receiving PD were exposed to PIPM and what characteristics were associated with exposure to PIPM.

Study Design: This was a retrospective longitudinal cohort analysis of patients who started PD in 2018 in the United States Renal Disease System database. Inclusion criteria were being >65 years of age, continuously enrolled in Medicare Part D for 12 months, and prescribed =1 medication(s) at the start of dialysis.

Methods: Prevalence of exposure to PIPM was determined at the start of dialysis and quarterly over one year. Logistic regression evaluated which patient characteristics (age, sex, race, Hispanic ethnicity, rurality, social deprivation index (SDI), United States region, polypharmacy, and diagnosis of diabetes and hypertension) were associated with exposure to =1 PIPM at the start of PD.

Results: There were 3,760 patients included and 28.7% were exposed to PIPM at the start of dialysis and 21.8% were still exposed to PIPM by the end of the first year. Medications most identified as PIPM were gabapentin (3.8%), hydrochlorothiazide (3.8%), glimepiride (3.6%), fenofibrate (3.2%), famotidine (2.9%), rosuvastatin (2.9%), atenolol (2.6%), sitagliptin (1.3%), benazepril (1.0%), and chlorthalidone (1.0%). Patients with =4 vs. <4 medications were at 2.8-14.1 times the odds of being exposed to PIPM (<0.001). Other key characteristics associated with exposure to PIPM were =85 vs. <75 years of age (aOR 0.67, 95%CI 0.48-0.95 p=0.03), living in the South vs. the Northeast (aOR 1.30 95%CI 1.02-1.66, p=0.04) and diagnosis of diabetes (aOR 1.52, 95%CI 1.29-1.78, p<0.001).

Conclusion: This study found approximately 20-30% of patients with PD were exposed to PIPM during 2018-19. The results from this study support the need to create medication management programs to identify and decrease exposure to PIPM.

Presenting Author

Armando Silva Almodóvar PharmD
The 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