Original Research
Monday, October 14, 2024
01:00 PM–02:30 PM
Abstract
Introduction: Polypharmacy contributes to medication-related harm in older adults and increases the likelihood of potentially inappropriate medications (PIMs). Altered pharmacokinetics in advanced kidney disease further increases the risk of medication-related harm. Interventions to deprescribe in older adults with advanced kidney disease are needed to improve medication safety.
Research Question or Hypothesis:
What is the difference in number of medications, PIMs, and success of deprescribing among older adults with and without advanced kidney disease?
Study Design: Retrospective cohort study
Methods: Hospitalized patients 65 years and older admitted to a geriatric internal medicine teaching service were provided a comprehensive polypharmacy intervention developed by an interdisciplinary team. Data from this intervention were collected between 7/1/21-6/30/22 including number of home and discharge medications, number and type of medication therapy problem (MTP), and number and type of PIM. Successful deprescribing was defined as discontinuation of a PIM during hospitalization that was carried over to discharge. Patients were categorized as advanced kidney disease if estimated glomerular filtration rate (eGFR) was below 30ml/min/1.73m2 or known diagnosis of chronic kidney disease stages 4 or 5. Statistical comparison between groups was performed using T, Chi-square, or Wilcoxon tests as appropriate using SASv9.3.
Results: The study included 155 patients, of which 32 (20.6%) had advanced kidney disease group with eGFR of 14.1±7.3ml/min/1.73m2 with 7 having kidney failure on dialysis. In the non-advanced kidney disease group, the admission eGFR was 70.4±23.2ml/min/1.73m2. Results are in the table.
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eGFR=30ml/min/1.73m2 (n=123)
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eGFR<30ml/min/1.73m2 (n=32)
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P-value
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Admission medications, median (interquartile range)
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11 (8-17)
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11 (8.5-14)
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0.830
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Discharge medications, median (interquartile range)
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12 (8-15)
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10.5 (7.5-14)
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0.188
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MTPs, mean±standard deviation
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1.790.98
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2.06±1.01
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0.149
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PIMs, total n
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208
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53
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N/A
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Successful deprescribing, n (%)
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86 (41.3%)
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20 (37.7%)
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0.633
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Conclusion:
There was no difference in the degree of polypharmacy, number of PIMs, or successful deprescribing between older adults with advanced kidney disease compared to those without.
Presenting Author
Calvin Meaney PharmD, BCPS, FCCPUniversity at Buffalo School of Pharmacy and Pharmaceutical Sciences
Authors
Natalie Peunic PharmD Student
University at Buffalo School of Pharmacy and Pharmaceutical Sciences
Kevin Pham PharmD Student
University at Buffalo School of Pharmacy and Pharmaceutical Sciences
Zachary Wikerd MD
Erie County Medical Center