目的:多重用药是透析患者的一个重要临床问题,但尚未得到充分研究。我们调查了以人群为基础的接受血液透析(HD)或腹膜透析(PD)治疗的参与者中多重用药的患病率和成本。
方法:我们研究了艾伯塔省20岁以上的成年人,加拿大自2019年3月31日起接受HD或PD维护。我们将参与者分为0-29种感兴趣的药物类别的使用者,将年龄≥65岁的患者分为潜在不适当药物(PIM)的使用者/非使用者。我们计算了药物类别的数量,每日药丸负担,年度总成本,以及每位参与者的年度成本,并将其与艾伯塔省普通人群的年龄和性别相匹配的队列进行了比较。
结果:在HD(n=1.781)或PD(n=467)的2.248名参与者(平均年龄63岁;39%为女性)中,处方药物类别的中位数为6[四分位距(IQR)4,8];中位每日药丸负担为8.0(IQR4.6,12.6)丸/天,5%处方≥21.7粒/天,和16.5%的处方≥15粒/天。12%的人被开处方至少一种在肾衰竭中禁忌的药物。每位参与者的年度费用中位数为${\\$}3,831美元,所有参与者每年总计约${\\$}1,160万美元。当限制在年龄≥65的1.063名参与者时,PIM类别的中位数为2(IQR1,2),PIM药丸负荷中位数为1.2粒/天(IQR0.5,2.4)。与PD参与者相比,HD参与者每天的药丸负担相似,PIM的使用更高,以及每位参与者的年度成本较高。透析参与者的药丸负担和相关费用分别高出3倍和10倍以上,分别,与普通人群的匹配参与者相比。
结论:透析参与者使用处方药和相关费用明显高于普通人群。需要有效的方法来在透析人群中开出处方。
OBJECTIVE: Polypharmacy is a significant clinical issue for patients on dialysis but has been incompletely studied. We investigated the prevalence and costs of polypharmacy in a population-based cohort of participants treated with hemodialysis (HD) or peritoneal dialysis (PD).
METHODS: We studied adults aged ≥ 20 years in Alberta, Canada receiving maintenance HD or PD as of March 31, 2019. We characterized participants as users of 0-29 drug categories of interest and those aged ≥ 65 as users/non-users of potentially inappropriate medications (PIM). We calculated the number of drug categories, daily pill burden, total annual cost, and annual cost per participant, and compared this to an age- and sex-matched cohort from the general Alberta population.
RESULTS: Among 2 248 participants (mean age 63 years; 39% female) on HD (n = 1 781) or PD (n = 467), the median number of prescribed drug categories was 6 [interquartile range (IQR) 4, 8]; median daily pill burden was 8.0 (IQR 4.6, 12.6) pills/day, with 5% prescribed ≥ 21.7 pills/day, and 16.5% prescribed ≥ 15 pills/day. Twelve % were prescribed at least one drug that is contraindicated in kidney failure. The median annual per participant cost was ${\\$}$3,831, totaling approximately ${\\$}$11.6 million annually for all participants. When restricting to the 1 063 participants aged ≥ 65, the median number of PIM categories was 2 (IQR 1, 2), with a median PIM pill burden of 1.2 pills/day (IQR 0.5, 2.4). Compared to PD participants, HD participants had similar daily pill burden, higher use of PIM, and higher annual per participant cost. Pill burden and associated costs for participants on dialysis were more than 3-fold and 10-fold higher, respectively, compared to the matched participants from the general population.
CONCLUSIONS: Participants on dialysis have markedly higher use of prescription medications and associated costs than the general population. Effective methods to de-prescribe in the dialysis population are needed.