Postdoctoral Research Fellow The Ohio State University Columbus, United States
Background: Polypharmacy is common among chronic kidney disease (CKD) patients and is associated with higher risks of frailty, hospitalization, and all-caused of mortality. There is limited data on the prevalence, geographical patterns, and risk factors of polypharmacy.
Objectives: To measure the prevalence of polypharmacy (concurrent use of ≥5 medications) and hyperpolypharmacy (concurrent use of ≥10 medications), overall and by geographic regions and the associated risk factors.
Methods: A systematic review was conducted using PubMed, Scopus, and Web of Science, from inception to December 31, 2022. Observational studies that reported the prevalence of polypharmacy and hyperpolypharmacy among patients with CKD were selected. We extracted data on prevalence, patient numbers, commonly prescribed medications, and factors associated with polypharmacy.
Results: Of the 103 studies identified, 16 met our inclusion criteria. The overall weighted point prevalence of polypharmacy and hyperpolypharmacy among people with CKD was 73.5% (95%CI: 60.1% - 83.6%) and 37% (95%CI: 24% - 52%), respectively. Point prevalence estimates reported in Asian countries were found to be higher (78%, 95%CI: 45% - 93%) than those reported in European countries (75%, 95%CI: 65% - 82%) and North America (48%, 95%CI: 33% - 64%). Age, BMI, and the presence of chronic diseases such as diabetes, hypertension, and cardiovascular disease are the major risk factors of polypharmacy among all CKD patients. However, no significant difference was observed in different geographical locations. Cardiovascular drugs (ACE inhibitors, calcium channel blockers, and Beta-blockers), statins, PPIs, antidiabetic, and antithrombotic agents were the most commonly prescribed medications among people with CKD.
Conclusions: The findings of this study show that more than half of people with CKD are exposed to polypharmacy, and the prevalence of polypharmacy is higher in Asian countries. Future studies are warranted to estimate the overall cost associated with polypharmacy and adverse outcomes in different geographical locations.
