Am J Kidney Dis. 2021 May 21:S0272-6386(21)00622-3. doi: 10.1053/j.ajkd.2021.03.019. Online ahead of print.
RATIONALE & OBJECTIVES: Adults with chronic kidney disease (CKD) may be at increased risk of adverse effects from use of potentially inappropriate medications (PIMs). Our objective was to assess whether PIM exposure has an independent association with CKD progression, hospitalizations, mortality, or falls.
STUDY DESIGN: Retrospective observational study.
SETTING & PARTICIPANTS: Chronic Renal Insufficiency Cohort (CRIC) study; 3929 adults with CKD enrolled 2003-2008; followed prospectively until December 2011.
EXPOSURE: PIM exposure was defined as prescriptions for any medications to be avoided in older adults as defined by the 2015 American Geriatrics Society Beers Criteria.
OUTCOMES: Hospitalization count, death, a composite kidney disease endpoint of CKD progression or initiation of kidney replacement therapy (KRT), KRT, and fall events assessed one year after PIM exposure.
ANALYTICAL APPROACH: Logistic regression and Poisson regression to estimate the associations of PIM exposure with each outcome.
RESULTS: The most commonly prescribed PIMs were proton pump inhibitors and alpha blockers. In unadjusted models any PIM exposure (compared to none) was associated with hospitalizations, death, and fall events. After adjustment, exposure to 1, 2, or >3 PIMs had a graded association with a higher hospitalization rate: RR 1.09, 95% CI:1.01-1.17, RR 1.18, 95% CI:1.07-1.30, and RR 1.35, 95% CI:1.19-1.53, respectively, and higher odds of mortality: OR 1.19, 95% CI: 0.91-1.54, OR 1.62, 95% CI:1.21-2.17 and OR 1.65, 95% CI:1.14-2.41, respectively. In a cohort subset reporting falls (n=1109), prescriptions for ≥3 PIMs was associated with and increased risk of falls (adjusted OR 2.85, 95% CI:1.54-5.26). PIMs were not associated with CKD progression or KRT. Age did not modify the association between PIM count and outcomes.
LIMITATIONS: Measurement bias; confounding by indication.
CONCLUSIONS: Adults of any age with CKD who are prescribed PIMs have an increased risk of hospitalization, mortality, and falls with the greatest risk occurring after more than one PIM prescription.