Evaluation of Changes Over Time in the Drug Burden and Medication Regimen Complexity in ESRD Patients Before and After Renal Transplantation

Kidney International Reports, Journal Year: 2020, Volume and Issue: 6(1), P. 128 - 137

Published: Oct. 17, 2020

BackgroundMedication regimen complexity (MRC) has not been characterized in detail patients with end-stage renal disease (ESRD). The objective of the present study was to quantify changes over time prescription drug burden and MRC ESRD (before transplantation, on discharge after kidney transplantation [M0], 4 months [M4] 12 [M12] afterward).MethodsWe retrospectively studied adult having undergone transplantation. number types prescribed, pill burden, index (MRCI) at different points M0, M4, M12) were extracted from patients' medical records. MRCI calculated by adding each score (calculated according its formulation, dosing frequency, additional instructions concerning administration). Hence, took account all drugs. A logistic regression model used identify factors associated an elevated M12.ResultsThe median (interquartile range) age 354 participants 52 years (42–62). Respectively 21%, 42%, 53%, 38% taking 10 or more drugs before M12. At M12, 3 most frequently prescribed classes immunosuppressants, cardiovascular system drugs, acting alimentary tract metabolism. significantly lower (P < 0.001) than point Diabetes dyslipidemia independently M12.ConclusionIn transplant recipients, greater impact medication adherence clinical outcomes these requires further evaluation. Medication afterward). We In

Language: Английский

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Polypharmacy and medication use in patients with chronic kidney disease with and without kidney replacement therapy compared to matched controls

Clinical Kidney Journal, Journal Year: 2021, Volume and Issue: 14(12), P. 2497 - 2523

Published: June 28, 2021

This study aims to examine polypharmacy (PP) prevalence in patients with chronic kidney disease (CKD) Stage G4/G5 and replacement therapy (KRT) compared matched controls from the general population. Furthermore, we risk factors for PP describe most commonly dispensed medications.Dutch health claims data were used identify three patient groups: CKD G4/G5, dialysis transplant patients. Each was two based on age, sex socio-economic status (SES) score. We differentiated between 'all medication use' 'chronic use'. defined at levels: use of ≥5 medications (PP), ≥10 [excessive (EPP)] ≥15 [hyper (HPP)].The all 87, 93 95% patients, respectively. For use, this 66, 70 75%, comorbidity higher than controls. EPP 42 times more common young (ages 20-44 years) controls, while ratio 3.8 ≥75 years. Older age (64-75 a factor Dialysis years had lower their younger counterparts. Additional low SES, diabetes mellitus, vascular disease, hospitalization an emergency room visit. The proton pump inhibitors (PPIs) statins.CKD KRT have high burden, far beyond that individuals population, as result large burden comorbidities. A critical approach prescription general, specific like PPIs statins (in population), could be first step towards appropriate use.

Language: Английский

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Ageing meets kidney disease

Clinical Kidney Journal, Journal Year: 2022, Volume and Issue: 15(10), P. 1793 - 1796

Published: June 30, 2022

Chronic kidney disease (CKD) is defined as abnormalities of structure or function, present for ˃3 months, with implications health. The most used diagnostic criteria are a urinary albumin: creatinine ratio ≥30 mg/g an estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m

Language: Английский

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Pill-burden and its association with treatment burden among patients with advanced stages of chronic kidney disease

Saudi Pharmaceutical Journal, Journal Year: 2023, Volume and Issue: 31(5), P. 678 - 686

Published: March 18, 2023

Chronic kidney disease (CKD) is associated with multimorbidity and high treatment burden. Pill-burden one component of the overall However, little known about its magnitude contribution to burden among patients advanced stages CKD. This study aimed quantify pill-burden in dialysis-dependent vs. non-dialysis-dependent advanced-stage CKD association burden.This was a cross-sectional for assessment non-dialysis hemodialysis (HD)-dependent patients. quantified as "number pills/patient/week" through electronic medical record, while assessed using "Treatment Burden Questionnaire (TBQ)". Furthermore, oral parenteral medication also quantified. Data were analyzed both descriptive inferential analysis, including Mann - Whitney U test two-way between groups analysis variance (ANOVA).Among 280 included median (IQR) number prescribed chronic medications 12 (5.7) 3 (2) medications. The 112 (55) pills/week. HD experienced higher than [122 (61) 109 (33) pills/week]; however, this difference did not reach statistical significance (p = 0.81). most commonly vitamin D (90.4%), sevelamer carbonate (65%), cinacalcet (67.5%), statins (67.1%). Overall, who had (≥112 pills/week) significantly perceived compared low (<112 [47(36.2) 38.5(36.7); p 0.0085]. ANOVA showed that dialysis status significant contributor treatment-burden group < 0.01), oral-medication-burden parenteral-medication-burden 0.004).Patients pill-burden, which increases burden; patient main factor affecting Future intervention studies should target population an aim reduce polypharmacy, burden, may ultimately improve patients' quality life.

Language: Английский

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The Effects of Pharmacist-Led Medication Therapy Management on Medication Adherence and Use of Non-Steroidal Anti-Inflammatory Drug in Patients with Pre-End Stage Renal Disease

Patient Preference and Adherence, Journal Year: 2024, Volume and Issue: Volume 18, P. 267 - 274

Published: Jan. 31, 2024

Patients with chronic kidney disease (CKD) are particularly vulnerable to the risks of polypharmacy, largely owing various comorbid conditions. This vulnerability is further compounded by an escalated risk renal function deterioration when exposed nephrotoxic medications. As part national health insurance program in Taiwan, pre-end-stage patient care and education plan has included pharmaceutical since October 2021. study aims explore effect pharmacist involvement a multidisciplinary team for patients outpatient settings.

Language: Английский

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Comparative Effectiveness of Cinacalcet Taken at‐Home Versus Three Times Weekly In‐Center on Controlling Calcium, Phosphate, and Parathyroid Hormone Levels

Hemodialysis International, Journal Year: 2025, Volume and Issue: unknown

Published: Jan. 30, 2025

ABSTRACT Introduction Chronic kidney disease‐mineral and bone disorder (CKD‐MBD), is a common syndrome in end stage disease (ESKD) patients, marked by dysregulation of electrolytes hormones, including calcium, phosphorus parathyroid hormone (PTH). Calcimemetics are cornerstone PTH lowering therapy; cinacalcet, an oral calcimemetic, the most used typically prescribed as daily administration, thus contributing to high total pill burden this population. Recent clinical trials have provided evidence that administration cinacalcet at dialysis unit three times week might be safe effective treatment option. In study we sought evaluate comparative effectiveness delivered at‐home versus weekly in‐center. Methods This was retrospective matched cohort 2894 adult in‐center hemodialysis patients between January 01, 2008 September 30, 2022 who were started on for first time (group 1: use or group 2: administration). Patients (1:1) on: age, body mass index, dose, baseline phosphorous, PTH. followed until censoring (i.e., lost follow up) 12 months after baseline, whichever occurred first. The primary outcome achieving triple control PTH, calcium. Results Overall, had median patient age 63 (IQR: 55, 71) years, predominately Black (41.6%) male (56.5%), well other demographic characteristics, etiology ESKD. Fitted proportion model results show no statistical difference intermittent home (triple control). secondary outcomes phosphorous showed similar results. Calcium same 9 months, better controlled during remaining months. Conclusion well‐matched cohort, exists administering thrice prescribing at‐home.

Language: Английский

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Conservative Management for Kidney Failure

Advances in Kidney Disease and Health, Journal Year: 2025, Volume and Issue: 32(1), P. 24 - 32

Published: Jan. 1, 2025

Language: Английский

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Deprescribing in chronic kidney disease: An essential component of comprehensive medication management

American Journal of Health-System Pharmacy, Journal Year: 2025, Volume and Issue: unknown

Published: April 8, 2025

Language: Английский

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Less is More: Deprescribing Medications in Older Adults with Kidney Disease: A Review

Kidney360, Journal Year: 2021, Volume and Issue: 2(9), P. 1510 - 1522

Published: July 9, 2021

Due to age and impaired kidney function, older adults with disease are at increased risk of medication-related problems related hospitalizations. One proa ctive approach minimize this is deprescribing. Deprescribing refers the systematic process reducing or stopping a medication. Aside from preventing harm, deprescribing can potentially optimize patients’ quality life by aligning medications their goals care. For some patients, could involve less aggressive management diabetes and/or hypertension. In other instances, targets may include inappropriate that carry greater harm than benefit in adults, have questionable efficacy, including varying efficacy degree increase medication regimen complexity. We guide for clinicians utilize deprescribing, List, Evaluate, Shared Decision-Making, Support (LESS) framework. The LESS framework provides key considerations each step be tailored context individu al patients. Patient characteristics clinical events warrant consideration limited expectancy, cognitive impairment, health status changes, such as dialysis initiation recent hospitalization. acknowledge patient-, clinician-, system-level challenges depre scribing process. These patient hesitancy discussing care, clinician time constraints lack evidence-based guidelines, interoperable electronic records incentives However, novel tools designed facilitate future evidence on effectiveness help mitigate these barriers. This review foundational knowledge an emerging component practice research within nephrology.

Language: Английский

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Ageing meets kidney disease

Nephrology Dialysis Transplantation, Journal Year: 2022, Volume and Issue: 38(3), P. 523 - 526

Published: June 30, 2022

ABSTRACT Chronic kidney disease (CKD) is defined as abnormalities of structure or function, present for ˃3 months, with implications health. The most used diagnostic criteria are a urinary albumin: creatinine ratio ≥30 mg/g an estimated glomerular filtration rate (eGFR) &lt;60 mL/min/1.73 m2. Either these thresholds associated adverse health outcomes. GFR decreases age and the prevalence CKD highest in older adults; moreover, presence increased risk all-cause cardiovascular death related to accelerated ageing all ranges, absolute increase those aged ˃75 years. Indeed, premature more common outcome than progression failure requiring replacement therapy. progressive world population contributes projection that will become second cause before end century countries long life expectancy. current collection selected studies on published Age&Ageing, NDT CKJ provides overview key topics, including cognitive decline, sarcopaenia, wasting non-cardiovascular morbidity mortality, management gender differences progression.

Language: Английский

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