The numbers of prescriptions and daily pill burdens are similar for patients receiving hemodialysis (HD) compared with those receiving peritoneal dialysis (PD), whereas medication costs are much higher for patients undergoing HD, reports a study in Nephrology Dialysis Transplantation.
Using the population-based Alberta Kidney Disease Network, the researchers analyzed the prevalence and costs of polypharmacy among adults receiving maintenance dialysis. Among 2248 patients included in the analysis, 1781 were undergoing HD, and 467 were undergoing PD. Use of up to 29 medication categories was assessed for each patient; use of potentially inappropriate medications (PIMs) was evaluated for those aged 65 years or older. The numbers of drug categories, daily pill burden, and annual medication costs were compared with those of an age- and sex-matched general population. Costs were expressed in 2021 Canadian dollars.
Overall, the patients on dialysis had prescriptions from a median of six drug categories, with a median daily pill burden of eight pills per day. Some patients had even higher pill counts: 15 or more for 16.5% of patients and 21.7 or more for 5% of patients. Median daily pill burden was approximately eight in both the HD and PD groups compared with 2.3 in the matched population.
Median annual medication cost was $3381 per patient, amounting to approximately $11.6 million per year for all patients undergoing dialysis. The median cost was $4087 for patients undergoing HD versus $2982 for patients undergoing PD compared with $340 in the general population sample. “Miscellaneous” drugs accounted for 83% of costs for the top 10 medication categories, mainly reflecting costs for erythropoietin-stimulating agents. For 10% of patients on dialysis, annual costs exceeded $10,000.
Among patients aged 65 or older, the median number of PIMs prescribed was two in the HD group versus one in the PD group. Twelve percent of patients were prescribed at least one medication that was contraindicated in kidney failure.
There is incomplete evidence on polypharmacy and use of PIMs among patients on dialysis. This study documented high daily pill burdens and medication costs for patients who underwent both HD and PD. Drug costs were higher for patients who underwent HD, largely reflecting use of erythropoiesis-stimulating agents.
Use of contraindicated medications and PIMs is relatively common as well. The researchers highlight the need for regular medication review along with new interventions to reduce polypharmacy for patients on dialysis [Ghimire A, et al. Prescribing patterns and medications costs in patients on maintenance hemodialysis and peritoneal dialysis. Nephrol Dial Transpl, July 4, 2024. doi: 10.1093/ndt/gfae154].
