College of Pharmacy, Seoul National University, Seoul, Korea.
Research Institute of Pharmaceutical Science, Seoul National University, Seoul, Korea.
Sci Rep. 2019 Jul 18;9(1):10440. doi: 10.1038/s41598-019-46849-7.
Polypharmacy, the concurrent use of multiple medicines, could increase the risk of kidney dysfunction among older adults because it likely burdens the aging kidneys to excrete multiple pharmaceutical ingredients and their metabolites. This study aimed to examine the relation between polypharmacy and kidney dysfunction among older patients. A nested case-control study was conducted using the National Health Insurance Service - Senior Cohort (NHIS-SC, 2009-2013), representative of the Korean senior population. It consisted of all health insurance claims linked to records of mandatory health examination. Kidney dysfunction was defined as having an eGFR lower than 60, with a decline rate of 10% or more compared to the baseline eGFR. Polypharmacy was defined based on daily counts of pharmaceutical ingredients during one year prior to the case's event date. It was classified into polypharmacy (five to 10 ingredients) and excessive polypharmacy (10 or more ingredients). After matching case and control groups based on a range of potential confounders, conditional logistic regression was performed incorporating adjustments on disease-specific, medication-specific, and lifestyle-related risk factors. The matching resulted in 14,577 pairs of cases and controls. Exposure to polypharmacy was significantly associated with increase in the risk of kidney dysfunction; i.e., crude model (polypharmacy: OR = 1.572, 95% CI = 1.492-1.656; excessive polypharmacy: OR = 2.069, 95% CI = 1.876-2.283) and risk adjustment model (polypharmacy: OR = 1.213, 95% CI = 1.139-1.292; excessive polypharmacy: OR = 1.461, 95% CI = 1.303-1.639). The significant associations were robust across different definitions of kidney dysfunction. These findings inform healthcare providers and policy makers of the importance of polypharmacy prevention to protect older adults from kidney dysfunction.
多药治疗，即同时使用多种药物，可能会增加老年人肾功能障碍的风险，因为这可能会使老化的肾脏负担过重，难以排泄多种药物成分及其代谢物。本研究旨在探讨老年患者多药治疗与肾功能障碍之间的关系。该研究使用韩国全国健康保险服务-老年人队列（NHIS-SC，2009-2013 年）进行嵌套病例对照研究，该队列代表了韩国老年人群。它包括与强制性健康检查记录相关的所有健康保险索赔。肾功能障碍定义为 eGFR 低于 60，与基线 eGFR 相比下降 10%或更多。多药治疗是根据事件发生前一年每天的药物成分数量来定义的。它分为多药治疗（5-10 种成分）和过度多药治疗（10 种或更多成分）。在基于一系列潜在混杂因素匹配病例和对照组后，采用条件逻辑回归方法，纳入疾病特异性、药物特异性和生活方式相关危险因素进行调整。匹配后得到 14577 对病例和对照组。暴露于多药治疗与肾功能障碍风险增加显著相关；即，未经调整模型（多药治疗：OR=1.572，95%CI=1.492-1.656；过度多药治疗：OR=2.069，95%CI=1.876-2.283）和风险调整模型（多药治疗：OR=1.213，95%CI=1.139-1.292；过度多药治疗：OR=1.461，95%CI=1.303-1.639）。在不同的肾功能障碍定义中，这些关联都是稳健的。这些发现提醒医疗保健提供者和政策制定者注意多药治疗预防的重要性，以保护老年人免受肾功能障碍的影响。
