International prescribing patterns and polypharmacy in older people with advanced chronic kidney disease: results from the European Quality study
International prescribing patterns and polypharmacy in older people with advanced chronic kidney disease: results from the European Quality study
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DOI：
10.1093/ndt/gfaa064
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发表时间：
2021-03-01
影响因子：
6.1
通讯作者：
Caskey, Fergus J.
中科院分区：
文献类型：
--
作者：
Hayward, Samantha;Hole, Barnaby;Caskey, Fergus J.
背景慢性肾脏病（CKD）患者是多重用药的高危人群。然而，以前没有研究调查了这一组的国际处方模式。本文旨在研究处方和多药模式的老年人与先进的慢性肾脏病在欧洲质量（EQUAL）研究所涉及的国家。EQUAL研究是一项在≥ 65岁的晚期CKD患者中开展的国际前瞻性队列研究。分析并连续报告基线人口统计学、临床和药物数据。多重用药定义为>= 5种药物，过度多重用药定义为>= 10种药物。单变量和多变量线性回归被用来确定国家和处方药数量之间的关联。单变量和多变量logistic回归分析用于确定国家和药物过度多元化之间的关联。在来自五个欧洲国家的1317名参与者中，91%的人正在经历多种药物治疗，43%的人正在经历超多种药物治疗。心血管药物是最常用的处方药（平均每人3.5）。在处方方面存在国际差异，德国的多重用药率显著更高{比值比（OR）2.75 [95%置信区间（CI）1.73-4.37]; P < 0.001，参考组英国}，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]。波兰的人经历了最少的多重用药[OR 0.39（95%CI 0.17-0.87）; P = 0.021]。过度用药在患有晚期CKD的老年人中很常见，处方药物的数量存在显著的国际差异。实践差异可能代表对这一高风险人群的适当处方缺乏共识，对他们来说，药物治疗既有潜在的危害，也有潜在的获益。
Background. 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.Methods. 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.Results. 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].Conclusions. 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.