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Polypharmacy and Kidney Function in Community-Dwelling Adults Age 60 Years and Older: A Prospective Observational Study


Ernst, Rahel; Fischer, Karina; de Godoi Rezende Costa Molino, Caroline; Orav, Endel J; Theiler, Robert; Meyer, Ursina; Fischler, Manuel; Gagesch, Michael; Ambühl, Patrice M; Freystätter, Gregor; Egli, Andreas; Bischoff-Ferrari, Heike A (2020). Polypharmacy and Kidney Function in Community-Dwelling Adults Age 60 Years and Older: A Prospective Observational Study. Journal of the American Medical Directors Association, 21(2):254-259.e1.

Abstract

Objectives
Information on the impact of polypharmacy on kidney function in older adults is limited. We prospectively investigated the association between intake of total number of drugs or nonsteroidal anti-inflammatory drugs (NSAIDs) and kidney function.
Design
Our study is a prospective observational analysis of the 2-year Zurich Multiple Endpoint Vitamin D Trial in Knee Osteoarthritis Patients.
Setting and participants
Of the 273 participants of the original trial, 270 participants (mean age 70.3 ± 6.4 years, 53% women) were included in this observational analysis.
Methods
The associations between (1) total number of drugs (or NSAIDs) at baseline or (2) cumulative number of drugs (or NASAIDs) repeatedly measured over 24 months and kidney function repeatedly measured over 24 months as estimated glomerular filtration rate (eGFR) were investigated using multivariable-adjusted repeated-measures analysis.
Results
Per drug at baseline, kidney function decreased by 0.64 mL/min/1.73 m2 eGFR (Beta = −0.64; 95% CI −1.19 to −0.08; P = .024) over 24 months. With every additional drug taken cumulatively over 24 months, kidney function decreased by 0.39 mL/min/1.73 m2 eGFR (Beta = −0.39; 95% CI −0.63 to −0.15; P = .002). In a high-risk subgroup, per NSAID taken cumulatively over 24 months, kidney function declined by 1.21 mL/min/1.73 m2 eGFR (Beta = −1.21; 95% CI −2.35 to −0.07; P = .021).
Conclusions and implications
For every additional drug prescribed among older adults, our study supports an independent and immediate harmful impact on kidney function. This negative impact seems to be about 3 times greater for NSAIDs compared with an additional average drug.

Abstract

Objectives
Information on the impact of polypharmacy on kidney function in older adults is limited. We prospectively investigated the association between intake of total number of drugs or nonsteroidal anti-inflammatory drugs (NSAIDs) and kidney function.
Design
Our study is a prospective observational analysis of the 2-year Zurich Multiple Endpoint Vitamin D Trial in Knee Osteoarthritis Patients.
Setting and participants
Of the 273 participants of the original trial, 270 participants (mean age 70.3 ± 6.4 years, 53% women) were included in this observational analysis.
Methods
The associations between (1) total number of drugs (or NSAIDs) at baseline or (2) cumulative number of drugs (or NASAIDs) repeatedly measured over 24 months and kidney function repeatedly measured over 24 months as estimated glomerular filtration rate (eGFR) were investigated using multivariable-adjusted repeated-measures analysis.
Results
Per drug at baseline, kidney function decreased by 0.64 mL/min/1.73 m2 eGFR (Beta = −0.64; 95% CI −1.19 to −0.08; P = .024) over 24 months. With every additional drug taken cumulatively over 24 months, kidney function decreased by 0.39 mL/min/1.73 m2 eGFR (Beta = −0.39; 95% CI −0.63 to −0.15; P = .002). In a high-risk subgroup, per NSAID taken cumulatively over 24 months, kidney function declined by 1.21 mL/min/1.73 m2 eGFR (Beta = −1.21; 95% CI −2.35 to −0.07; P = .021).
Conclusions and implications
For every additional drug prescribed among older adults, our study supports an independent and immediate harmful impact on kidney function. This negative impact seems to be about 3 times greater for NSAIDs compared with an additional average drug.

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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Clinic for Geriatric Medicine
Dewey Decimal Classification:610 Medicine & health
Uncontrolled Keywords:General Nursing, Health Policy, General Medicine
Language:English
Date:1 February 2020
Deposited On:18 Dec 2019 15:38
Last Modified:24 Jan 2020 02:04
Publisher:Elsevier
ISSN:1525-8610
OA Status:Green
Free access at:Publisher DOI. An embargo period may apply.
Publisher DOI:https://doi.org/10.1016/j.jamda.2019.07.007
PubMed ID:31501003

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