UK Renal Registry, Southmead Hospital, Bristol, UK.
Bristol Medical School, University of Bristol, Bristol, UK.
Nephrol Dial Transplant. 2021 Feb 20;36(3):503-511. doi: 10.1093/ndt/gfaa064.
People with chronic kidney disease (CKD) are at high risk of polypharmacy. However, no previous study has investigated international prescribing patterns in this group. This article aims to examine prescribing and polypharmacy patterns among older people with advanced CKD across the countries involved in the European Quality (EQUAL) study.
The EQUAL study is an international prospective cohort study of patients ≥65 years of age with advanced CKD. Baseline demographic, clinical and medication data were analysed and reported descriptively. Polypharmacy was defined as ≥5 medications and hyperpolypharmacy as ≥10. Univariable and multivariable linear regressions were used to determine associations between country and the number of prescribed medications. Univariable and multivariable logistic regression were used to determine associations between country and hyperpolypharmacy.
Of the 1317 participants from five European countries, 91% were experiencing polypharmacy and 43% were experiencing hyperpolypharmacy. Cardiovascular medications were the most prescribed medications (mean 3.5 per person). There were international differences in prescribing, with significantly greater hyperpolypharmacy in Germany {odds ratio (OR) 2.75 [95% confidence interval (CI) 1.73-4.37]; P < 0.001, reference group UK}, the Netherlands [OR 1.91 (95% CI 1.32-2.76); P = 0.001] and Italy [OR 1.57 (95% CI 1.15-2.15); P = 0.004]. People in Poland experienced the least hyperpolypharmacy [OR 0.39 (95% CI 0.17-0.87); P = 0.021].
Hyperpolypharmacy is common among older people with advanced CKD, with significant international differences in the number of medications prescribed. Practice variation may represent a lack of consensus regarding appropriate prescribing for this high-risk group for whom pharmacological treatment has great potential for harm as well as benefit.
患有慢性肾脏病（CKD）的人有发生多种药物治疗的高风险。然而，以前没有研究调查过该人群的国际处方模式。本文旨在研究参与欧洲质量（EQUAL）研究的国家中，患有晚期 CKD 的老年人的处方和多种药物治疗模式。
EQUAL 研究是一项针对≥65 岁患有晚期 CKD 的患者的国际前瞻性队列研究。对基线人口统计学、临床和药物数据进行了分析和描述性报告。多种药物治疗定义为≥5 种药物，超多种药物治疗定义为≥10 种药物。使用单变量和多变量线性回归来确定国家与所开药物数量之间的关联。使用单变量和多变量逻辑回归来确定国家与超多种药物治疗之间的关联。
在来自五个欧洲国家的 1317 名参与者中，91%的人正在接受多种药物治疗，43%的人正在接受超多种药物治疗。心血管药物是最常开的药物（每人平均 3.5 种）。在处方方面存在国际差异，德国、荷兰和意大利的超多种药物治疗的发生率明显更高[德国：比值比（OR）2.75（95%置信区间（CI）1.73-4.37）；P<0.001，参照组为英国]、荷兰[OR 1.91（95% CI 1.32-2.76）；P=0.001]和意大利[OR 1.57（95% CI 1.15-2.15）；P=0.004]。波兰的人接受超多种药物治疗的人数最少[OR 0.39（95% CI 0.17-0.87）；P=0.021]。
患有晚期 CKD 的老年人中，超多种药物治疗很常见，处方药物数量存在显著的国际差异。实践差异可能表明，对于这个高风险人群，在药物治疗方面缺乏共识，这种治疗方法既有潜在的益处，也有潜在的危害。
