Peking University Center for Public Health and Epidemic Preparedness and Response, Peking University, Beijing, China.
Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine, Osaka, Japan.
Front Public Health. 2023 Mar 23;11:1116583. doi: 10.3389/fpubh.2023.1116583. eCollection 2023.
Polypharmacy might contribute to a range of adverse outcomes, which could get worse in the elderly with chronic kidney disease (CKD). Evidence on polypharmacy, CKD, and mortality is scarce. We aimed to investigate the prospective association between polypharmacy, CKD and all-cause and cause-specific mortality in adults aged ≥65 years.
A total of 13,513 adults from the National Health and Nutrition Examination Surveys were included, following up from 1999 to 2018 until December 31, 2019. The simultaneous use of ≥5 medications by one individual was defined as polypharmacy. Survey-weighted Cox proportional hazard models were used to estimate the hazard ratio (HRs) for mortality from all-cause, cardiovascular diseases (CVD), and cancer after adjusting for potential confounding factors.
Among the elderly with CKD, we identified 3,825 total deaths (1,325 CVD and 714 cancer) during a median follow-up of 7.7 years. Participants with polypharmacy had a 27% (HR = 1.27 [1.15, 1.39]) and 39% (HR = 1.39 [1.19, 1.62]) higher risk of all-cause and CVD mortality, respectively, but not for cancer mortality. Compared with the elderly with no polypharmacy and no CKD, the corresponding HRs (95%CIs) for all-cause mortality were 1.04 (0.96, 1.14) for those with no polypharmacy but CKD, 1.24 (1.11, 1.39) for with polypharmacy but no CKD, and 1.34 (1.21, 1.49) for those with both polypharmacy and CKD. A similar pattern was detected for CVD mortality.
Polypharmacy was associated with elevated risks of all-cause and CVD mortality among the elderly CKD patients. More evidence-based approaches should be promoted for the appropriate deprescribing in the older adults with CKD.
多种药物治疗可能会导致一系列不良后果，而在患有慢性肾脏病（CKD）的老年人中，这些后果可能会更严重。关于多种药物治疗、CKD 和死亡率的证据很少。我们旨在研究≥65 岁成年人中多种药物治疗、CKD 与全因和特定原因死亡率之间的前瞻性关联。
共有 13513 名成年人来自国家健康和营养检查调查，从 1999 年到 2018 年进行随访，直至 2019 年 12 月 31 日。将一个人同时使用≥5 种药物定义为多种药物治疗。使用调查加权 Cox 比例风险模型来估计全因、心血管疾病（CVD）和癌症死亡率的风险比（HRs），并调整潜在混杂因素。
在患有 CKD 的老年人中，我们在中位随访 7.7 年期间发现了 3825 例总死亡（1325 例 CVD 和 714 例癌症）。使用多种药物治疗的患者全因死亡率的风险增加了 27%（HR=1.27 [1.15, 1.39]），CVD 死亡率的风险增加了 39%（HR=1.39 [1.19, 1.62]），但癌症死亡率没有增加。与没有多种药物治疗且没有 CKD 的老年人相比，全因死亡率的相应 HR（95%CI）分别为没有多种药物治疗但患有 CKD 的患者为 1.04（0.96, 1.14），有多种药物治疗但没有 CKD 的患者为 1.24（1.11, 1.39），以及既有多种药物治疗又有 CKD 的患者为 1.34（1.21, 1.49）。CVD 死亡率也出现了类似的模式。
多种药物治疗与 CKD 老年患者的全因和 CVD 死亡率升高有关。应推广更多基于证据的方法，以在患有 CKD 的老年人中进行适当的药物减量。
