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Cumulative Cardiovascular Polypharmacy Is Associated With the Risk of Acute Kidney Injury in Elderly Patients.

Publication ,  Journal Article
Chao, C-T; Tsai, H-B; Wu, C-Y; Lin, Y-F; Hsu, N-C; Chen, J-S; Hung, K-Y
Published in: Medicine (Baltimore)
August 2015

Polypharmacy is common in the elderly due to multimorbidity and interventions. However, the temporal association between polypharmacy and renal outcomes is rarely addressed and recognized. We investigated the association between cardiovascular (CV) polypharmacy and the risk of acute kidney injury (AKI) in elderly patients.We used the Taiwan National Health Insurance PharmaCloud system to investigate the relationship between cumulative CV medications in the 3 months before admission and risk of AKI in the elderly at their admission to general medical wards in a single center. Community-dwelling elderly patients (>60 years) were prospectively enrolled and classified according to the number of preadmission CV medications. CV polypharmacy was defined as use of 2 or more CV medications.We enrolled 152 patients, 48% with AKI (based upon Kidney Disease Improving Global Outcomes [KDIGO] classification) and 64% with CV polypharmacy. The incidence of AKI was higher in patients taking more CV medications (0 drugs: 33%; 1 drug: 50%; 2 drugs: 57%; 3 or more drugs: 60%; P = 0.05) before admission. Patients with higher KDIGO grades also took more preadmission CV medications (P = 0.04). Multiple regression analysis showed that patients who used 1 or more CV medications before admission had increased risk of AKI at admission (1 drug: odds ratio [OR] = 1.63, P = 0.2; 2 drugs: OR = 4.74, P = 0.03; 3 or more drugs: OR = 5.92, P = 0.02), and that CV polypharmacy is associated with higher risk of AKI (OR 2.58; P = 0.02). Each additional CV medication increased the risk for AKI by 30%.We found that elderly patients taking more CV medications are associated with risk of adverse renal events. Further study to evaluate whether interventions that reduce polypharmacy could reduce the incidence of geriatric AKI is urgently needed.

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Published In

Medicine (Baltimore)

DOI

EISSN

1536-5964

Publication Date

August 2015

Volume

94

Issue

31

Start / End Page

e1251

Location

United States

Related Subject Headings

  • Risk Factors
  • Regression Analysis
  • Prospective Studies
  • Polypharmacy
  • Odds Ratio
  • Middle Aged
  • Male
  • Humans
  • Female
  • Cardiovascular Agents
 

Citation

APA
Chicago
ICMJE
MLA
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Chao, C.-T., Tsai, H.-B., Wu, C.-Y., Lin, Y.-F., Hsu, N.-C., Chen, J.-S., & Hung, K.-Y. (2015). Cumulative Cardiovascular Polypharmacy Is Associated With the Risk of Acute Kidney Injury in Elderly Patients. Medicine (Baltimore), 94(31), e1251. https://doi.org/10.1097/MD.0000000000001251
Chao, Chia-Ter, Hung-Bin Tsai, Chia-Yi Wu, Yu-Feng Lin, Nin-Chieh Hsu, Jin-Shin Chen, and Kuan-Yu Hung. “Cumulative Cardiovascular Polypharmacy Is Associated With the Risk of Acute Kidney Injury in Elderly Patients.Medicine (Baltimore) 94, no. 31 (August 2015): e1251. https://doi.org/10.1097/MD.0000000000001251.
Chao C-T, Tsai H-B, Wu C-Y, Lin Y-F, Hsu N-C, Chen J-S, et al. Cumulative Cardiovascular Polypharmacy Is Associated With the Risk of Acute Kidney Injury in Elderly Patients. Medicine (Baltimore). 2015 Aug;94(31):e1251.
Chao, Chia-Ter, et al. “Cumulative Cardiovascular Polypharmacy Is Associated With the Risk of Acute Kidney Injury in Elderly Patients.Medicine (Baltimore), vol. 94, no. 31, Aug. 2015, p. e1251. Pubmed, doi:10.1097/MD.0000000000001251.
Chao C-T, Tsai H-B, Wu C-Y, Lin Y-F, Hsu N-C, Chen J-S, Hung K-Y. Cumulative Cardiovascular Polypharmacy Is Associated With the Risk of Acute Kidney Injury in Elderly Patients. Medicine (Baltimore). 2015 Aug;94(31):e1251.

Published In

Medicine (Baltimore)

DOI

EISSN

1536-5964

Publication Date

August 2015

Volume

94

Issue

31

Start / End Page

e1251

Location

United States

Related Subject Headings

  • Risk Factors
  • Regression Analysis
  • Prospective Studies
  • Polypharmacy
  • Odds Ratio
  • Middle Aged
  • Male
  • Humans
  • Female
  • Cardiovascular Agents