High disease and medication exposure burden associated with patients on chronic dialysis

IRBexempt#2018-197.Background:Patients with end stage renal disease(ESRD), in addition to chronic dialysis, also receive multiple drug therapies for co-morbidities;Patients manage on average, 10-12 daily medications in regimens, increasing the risk of drug-related adverse effects and medication nonadherence. We want to determine the most common P2Y12-I taken by patients and other medications frequently used by this group. Methods:A retrospective cohort of ESRD patients started on a P2Y12-I between July 20,2011 and December 31,2014 was identified through United States Renal Data System(USRDS) registry data. Within USRDS, we used Medicare Part A, Part B, and mostly Part D pharmacy claims to accurately capture entire prescription filling number to this patient population. Results:The study cohort was restricted to ESRD patients with a known first service date for dialysis prior to study end date, December 31, 2014. 36,590 patients were followed on average 367days(IQR:147, 1627). Median age for patients receiving P2Y12-I was 64(IQR: 55, 73), 54%male, 41%Caucasians. Patients were on dialysis for 3.8years, taking 7 medications(median:7, IQR:5,10) and had 7 different co-morbidities. Top10 medications routinely used (% of patients): Clopidogrel(95%), Sevelamer(39%), Amlodipine(32%), Carvedilol(30%), Calcium Acetate(28%), Metoprolol(27%), Lisinopril(26%), Atorvastatin(26%) and Cinacalcet HCL(26%). Majority medications were antihypertensive drugs and ion-removing agents. Conclusion:Due to the complex medication regimen and high rate of comorbidities in this population, de-prescribing methods may be the next step moving forwards. The goal of this method is to reduce medication burdens and drug adverse events while improving quality of life through targeted deprescribing methods.