Prevalence and patterns of polypharmacy in peritoneal dialysis patients: an experience from a general hospital in Thailand

Main Article Content

Supap Makruasi
Nisa Makruasi

Abstract

Patients on peritoneal dialysis  have a burden from comorbidities and risk of medication prescription. Our study aimed to determine the prevalence, patterns, and factors associated with polypharmacy in peritoneal dialysis patients. A single-center cross-sectional study was conducted in a sample of 245 patients who were undergoing peritoneal dialysis. Polypharmacy is defined as five or more medications per day. The results of our study showed that the prevalence of polypharmacy was 96%. The most common drug prescription type was blood pressure-lowering agents. In the multivariate model, only hypertension was a significant independent factor associated with polypharmacy (OR 6.97; 95%CI 1.34-36.15; p =0.021, after adjusting for age, gender, diabetes mellitus and dyslipidemia). In conclusion, a high prevalence of polypharmacy was identified in peritoneal dialysis patients in our study. Further studies should focus on drug interactions, awareness of medical nonadherence, and over-the-counter medication.  

Article Details

How to Cite
1.
Makruasi S, Makruasi N. Prevalence and patterns of polypharmacy in peritoneal dialysis patients: an experience from a general hospital in Thailand. J Public Hlth Dev [Internet]. 2021 Jan. 13 [cited 2024 Mar. 29];19(1):176-85. Available from: https://he01.tci-thaijo.org/index.php/AIHD-MU/article/view/244693
Section
Short Report
Author Biographies

Supap Makruasi, Department of Social Medicine, Nakhon Nayok Hospital, Nakhon Nayok, Thailand and Rational Drug Use Committee of Regional Health 4, Saraburi, Thailand

Department of Social Medicine, Nakhon Nayok Hospital, Nakhon Nayok, Thailand

Rational Drug Use Committee of Regional Health 4, Saraburi, Thailand

Nisa Makruasi, Department of Medicine, Faculty of Medicine, Srinakharinwirot University, Nakhon Nayok, Thailand

Department of Medicine, Faculty of Medicine, Srinakharinwirot University, Nakhon Nayok, Thailand

References

Saran R, Robinson B, Abbott KC, Bragg-Gresham J, Chen X, Gipson D, et al. US Renal Data System 2019 Annual Data Report: Epidemiology of Kidney Disease in the United States. Am J Kidney Dis. 2020;75(1 Suppl 1):A6-a7.

Changsirikulchai S, Sriprach S, Thokanit NS, Janma J, Chuengsaman P, Sirivongs D. Survival Analysis and Associated Factors in Thai Patients on Peritoneal Dialysis Under the PD-First Policy. Perit Dial Int. 2018;38(3):172-8.

Go AS, Chertow GM, Fan D, McCulloch CE, Hsu CY. Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med. 2004; 351(13):1296-305.

Titze S, Schmid M, Kottgen A, Busch M, Floege J, Wanner C, et al. Disease burden and risk profile in referred patients with moderate chronic kidney disease: composition of the German Chronic Kidney Disease (GCKD) cohort. Nephrol Dial Transplant. 2015; 30(3):441-51.

Morin L, Johnell K, Laroche ML, Fastbom J, Wastesson JW. The epidemiology of polypharmacy in older adults: register-based prospective cohort study. Clin Epidemiol. 2018; 10:289-98.

Fincke BG, Snyder K, Cantillon C, Gaehde S, Standring P, Fiore L, et al. Three complementary definitions of polypharmacy: methods, application and comparison of findings in a large prescription database. Pharmaco-epidemiol Drug Saf. 2005;14(2):121-8.

Lazarou J, Pomeranz BH, Corey PN. Incidence of adverse drug reactions in hospitalized patients: a meta-analysis of prospective studies. JAMA. 1998;279(15):1200-5.

Niclos G, Olivar T, Rodilla V. A cross-sectional evaluation of the prevalence and detection of predictors of polypharmacy amongst adult in Spain. Int J Pharm Pract. 2018;26(3):242-9.

Masnoon N, Shakib S, Kalisch-Ellett L, Caughey GE. What is polypharmacy? A systematic review of definitions. BMC Geriatr. 2017;17(1):230.

Alshamrani M, Almalki A, Qureshi M, Yusuf O, Ismail S. Polypharmacy and Medication-Related Problems in Hemodialysis Patients: A Call for Deprescribing. Pharmacy (Basel). 2018;6(3):76

Schmidt IM, Hübner S, Nadal J, Titze S, Schmid M, Bärthlein B, et al. Patterns of medication use and the burden of polypharmacy in patients with chronic kidney disease: the German Chronic Kidney Disease study. Clin Kidney J. 2019;12(5):663-72.

Campos LG, Bragg-Gresham J, Han Y, Moraes TP, Figueiredo AE, Barretti P, et al. Temporal Trends and Factors Associated with Medication Prescription Patterns in Peritoneal Dialysis Patients. Perit Dial Int. 2018;38(4):293-301.

Makboona K, Pongpaew W, Mit-tangkulra P. Polypharmacy situation in Thambol Tubteelek of Muang District, Suphanburi Province. Health and the Environment Journal. 2014;5(3):1-8.

Muangpaisan W, Pisalsalakij D, Intalapaporn S, Chatthanawaree W. Medication nonadherence in elderly patients in a Thai geriatric clinic. Asian Biomedicine. 2014;8(4):541.

Vatcharavongvan P, Puttawanchai V. Polypharmacy, medication adherence and medication management at home in elderly patients with multiple non-communicable diseases in Thai primary care. Family Medicine & Primary Care Review. 2017;19(4):412-6.

Manley HJ, Cannella CA, Bailie GR, St Peter WL. Medication-related problems in ambulatory hemodialysis patients: a pooled analysis. Am J Kidney Dis. 2005;46(4):669-80.

St Peter WL. Management of Polypharmacy in Dialysis Patients. Semin Dial. 2015;28(4):427-32.

Al-Sayyari AA, Shaheen FA. End stage chronic kidney disease in Saudi Arabia. A rapidly changing scene. Saudi Med J. 2011;32(4):339-46.

Manley HJ, Drayer DK, Muther RS. Medication-related problem type and appearance rate in ambulatory hemodialysis patients. BMC Nephrol. 2003;4:10.

Agarwal R, Sinha AD, Pappas MK, Abraham TN, Tegegne GG. Hypertension in hemodialysis patients treated with atenolol or lisinopril: a randomized controlled trial. Nephrol Dial Transplant. 2014;29(3):672-81.

London GM, Marchais SJ, Guerin AP, Metivier F, Safar ME, Fabiani F, et al. Salt and water retention and calcium blockade in uremia. Circulation. 1990;82(1):105-13.

Tepel M, Hopfenmueller W, Scholze A, Maier A, Zidek W. Effect of amlodipine on cardiovascular events in hypertensive haemodialysis patients. Nephrol Dial Transplant. 2008;23(11):3605-12.

Medcalf JF, Harris KP, Walls J. Role of diuretics in the preservation of residual renal function in patients on continuous ambulatory peritoneal dialysis. Kidney Int. 2001;59(3):1128-33.

Schneider MP, Hubner S, Titze SI, Schmid M, Nadal J, Schlieper G, et al. Implementation of the KDIGO guideline on lipid management requires a substantial increase in statin pre-scription rates. Kidney Int. 2015;88(6): 1411-8.

Boeschoten EW, Schrijver J, Krediet RT, Schreurs WH, Arisz L. Deficien-cies of vitamins in CAPD patients: the effect of supplementation. Nephrol Dial Transplant.1988;3(2):187-93.

Lasseur C, Parrot F, Delmas Y, Level C, Ged C, Redonnet-Vernhet I, et al. Impact of high-flux/high-efficiency dialysis on folate and homocysteine metabolism. J Nephrol. 2001;14(1):32-5.

Fehrman-Ekholm I, Lotsander A, Logan K, Dunge D, Odar-Cederlof I, Kallner A. Concentrations of vitamin C, vitamin B12 and folic acid in patients treated with hemodialysis and on-line hemodiafiltration or hemofiltration. Scand J Urol Nephrol. 2008;42(1):74-80.

Ortega LM, Materson BJ. Hypertension in peritoneal dialysis patients: epidemiology, pathogenesis, and treatment. J Am Soc Hypertens. 2011;5(3):128-36.

Sutaria A, Liu L, Ahmed Z. Multiple medication (polypharmacy) and chronic kidney disease in patients aged 60 and older: a pharmacoepidemiologic perspective. Ther Adv Cardiovasc Dis. 2016;10(4):242-50.

Pai AB, Cardone KE, Manley HJ, St Peter WL, Shaffer R, Somers M, et al. Medication reconciliation and therapy management in dialysis-dependent patients: need for a systematic approach. Clin J Am Soc Nephrol. 2013;8(11):1988-99.

Ledger S, Choma G. Medication reconciliation in hemodialysis patients. CANNT J. 2008;18(4):41-3.

Wilson JS, Ladda MA, Tran J, Wood M, Poyah P, Soroka S, et al. Ambulatory Medication Reconciliation in Dialysis Patients: Benefits and Community Practitioners' Perspectives. Can J Hos Pharm. 2017;70(6):443-9.