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Risks associated with continuation of potentially inappropriate antihypertensive medications in older adults receiving hemodialysis.

Publication ,  Journal Article
Hall, RK; Morton, S; Wilson, J; Ephraim, PL; Boulware, LE; St Peter, WL; Colón-Emeric, C; Pendergast, J; Scialla, JJ
Published in: BMC Nephrol
June 19, 2021

BACKGROUND AND OBJECTIVES: After dialysis initiation, older adults may experience orthostatic or post-dialysis hypotension. Some orthostasis-causing antihypertensives (i.e., central alpha agonists and alpha blockers), are considered potentially inappropriate medications (PIMs) for older adults because they carry more risk than benefit. We sought to (1) describe antihypertensive PIM prescribing patterns before and after dialysis initiation and (2) ascertain the potential risk of adverse outcomes when these medications are continued after dialysis initiation. DESIGN, SETTING, PARTICIPANTS, AND MEASUREMENTS: Using United States Renal Data System data, we evaluated monthly prevalence of antihypertensive PIM claims in the period before and after dialysis initiation among older adults aged ≥66 years initiating in-center hemodialysis in the US between 2013 and 2014. Patients with an antihypertensive PIM prescription at hemodialysis initiation and who survived for 120 days were classified as 'continuers' or 'discontinuers' based on presence or absence of a refill within the 120 days after initiation. We compared rates of hospitalization and risk of death across these groups from day 121 through 24 months after dialysis initiation. RESULTS: Our study included 30,760 total patients, of whom 5981 (19%) patients had an antihypertensive PIM claim at dialysis initiation and survived ≥120 days. Most [65% (n = 3920)] were continuers. Those who continued (versus discontinued) were more likely to be black race (26% versus 21%), have dual Medicare-Medicaid coverage (31% versus 27%), have more medications on average (12 versus 9) and have no functional limitations (84% versus 80%). Continuers experienced fewer all-cause hospitalizations and deaths, but neither were statistically significant after adjustment (Hospitalization: RR 0.93, 95% CI 0.86, 1.00; Death: HR 0.89, 95% CI: 0.78-1.02). CONCLUSIONS: Nearly one in five older adults had an antihypertensive PIM at dialysis initiation. Among those who survived ≥120 days, continuation of an antihypertensive PIM was not associated with increased risk of all-cause hospitalization or mortality.

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Published In

BMC Nephrol

DOI

EISSN

1471-2369

Publication Date

June 19, 2021

Volume

22

Issue

1

Start / End Page

232

Location

England

Related Subject Headings

  • Urology & Nephrology
  • Risk Assessment
  • Retrospective Studies
  • Renal Dialysis
  • Practice Patterns, Physicians'
  • Potentially Inappropriate Medication List
  • Male
  • Kidney Failure, Chronic
  • Hypotension, Orthostatic
  • Humans
 

Citation

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Hall, R. K., Morton, S., Wilson, J., Ephraim, P. L., Boulware, L. E., St Peter, W. L., … Scialla, J. J. (2021). Risks associated with continuation of potentially inappropriate antihypertensive medications in older adults receiving hemodialysis. BMC Nephrol, 22(1), 232. https://doi.org/10.1186/s12882-021-02438-3
Hall, Rasheeda K., Sarah Morton, Jonathan Wilson, Patti L. Ephraim, L Ebony Boulware, Wendy L. St Peter, Cathleen Colón-Emeric, Jane Pendergast, and Julia J. Scialla. “Risks associated with continuation of potentially inappropriate antihypertensive medications in older adults receiving hemodialysis.BMC Nephrol 22, no. 1 (June 19, 2021): 232. https://doi.org/10.1186/s12882-021-02438-3.
Hall RK, Morton S, Wilson J, Ephraim PL, Boulware LE, St Peter WL, et al. Risks associated with continuation of potentially inappropriate antihypertensive medications in older adults receiving hemodialysis. BMC Nephrol. 2021 Jun 19;22(1):232.
Hall, Rasheeda K., et al. “Risks associated with continuation of potentially inappropriate antihypertensive medications in older adults receiving hemodialysis.BMC Nephrol, vol. 22, no. 1, June 2021, p. 232. Pubmed, doi:10.1186/s12882-021-02438-3.
Hall RK, Morton S, Wilson J, Ephraim PL, Boulware LE, St Peter WL, Colón-Emeric C, Pendergast J, Scialla JJ. Risks associated with continuation of potentially inappropriate antihypertensive medications in older adults receiving hemodialysis. BMC Nephrol. 2021 Jun 19;22(1):232.
Journal cover image

Published In

BMC Nephrol

DOI

EISSN

1471-2369

Publication Date

June 19, 2021

Volume

22

Issue

1

Start / End Page

232

Location

England

Related Subject Headings

  • Urology & Nephrology
  • Risk Assessment
  • Retrospective Studies
  • Renal Dialysis
  • Practice Patterns, Physicians'
  • Potentially Inappropriate Medication List
  • Male
  • Kidney Failure, Chronic
  • Hypotension, Orthostatic
  • Humans