Medication Burden and Regimen Complexity Among Dialysis Patients from 2003 to 2024
Harold J. Manley, Nien Chen Li, Scot Born, Caroline M. Hsu, Daniel E. Weiner, Dana C. Miskulin, Antonia M. Harford, Doug Johnson, Eduardo K. LacsonBackground:
Medication burden is a significant clinical issue for patients receiving maintenance dialysis. Studies characterizing medication burden are often limited to a single time point. We investigated the change in medication burden for patients over a 22-year period at a large national not-for-profit dialysis organization.
Methods:
Patients ≥18 years of age receiving maintenance hemodialysis (HD) or peritoneal dialysis (PD) as of October 1 of each year between 2003-2024 were included. Medication burden was characterized as: number of active medications on profile, polypharmacy prevalence (≥10 medications), number of pills/capsules per day, and medication regimen complexity index (MRCI). Medications were classified into therapeutic categories. Patients’ demographic, clinical characteristics, and medication burden were summarized overall and each year during the study period and were stratified by modality. Trend analyses for longitudinal medication burden measures were performed using generalized linear models with generalized estimating equations for repeated measures.
Results:
Among 82,549 distinct patients [HD 72,412 (88%); PD 10,137 (12%) at dialysis initiation], mean age was 62 ±15 years and 44% were female. For per patient-day, number of medication increased from 13.4 to 15.9 (mean yearly rate of increase 0.23, 95% CL 0.22-0.24); pill burden increased from 18.1 to 18.6 (mean 0.16, 95% CL 0.15-0.17); and MRCI increased from 29.3 to 35.0 (mean 0.54, 95% CL 0.53-0.56). Polypharmacy was initially present in 77% of patients and increased to 87% (yearly increase in odds of using 10 or more medications per day 5.1%, 95% CL 4.9-5.4). Treatments for mineral and metabolic bone disease and cardiovascular disease contributed most to medication burden.
Conclusion:
Medication burden increased over the last two decades in patients receiving maintenance dialysis.