#2297 Impact of dialysis initiation on drug use patterns in older patients: results from the French national renal replacement therapy registry matched with the national health data system (SNDS)

Le résumé fourni par la source

Abstract Background and Aims Older dialysis patients have complex drug regimen to manage their chronic kidney disease, associated complications, and comorbidities. Our aim was to describe the drug use patterns during the year preceding and following dialysis initiation in patients aged 65 years and older. Method All patients initiating chronic dialysis in France at 65 years and older between 2010 and 2019 were identified from the national renal replacement therapy registry (REIN). They were included if they were deterministically matched with the national health data system (SNDS) (85.5%). Drug use prevalence was described by pharmacotherapeutic classes, based on anatomical therapeutic chemical (ATC) codes, and estimated quarterly for patients with at least one drug dispensing within the period. Analysis was stratified according to the dialysis modality: hemodialysis (HD) or peritoneal dialysis (PD), sex, age and calendar year (2010–2019) at dialysis initiation. Results Among 55,238 patients included, 76.0% had hyperpolypharmacy (≥10 drugs delivered) at dialysis initiation. Non-dialysis-related drugs, including glucose-lowering, psychotropic, analgesic and non-antihypertensive cardiovascular drugs, showed stable prevalence between the period before and after dialysis initiation, except a transient bound in analgesic use just before dialysis initiation (47.5% to 52.3%) (Fig. 1). Conversely, dialysis-related drugs showed variations in prevalence. Antihypertensive use decreased at dialysis initiation (88.3% to 71.8%), particularly in HD patients, except for diuretics (Fig. 1). Potassium binders (31.1% to 23.6%) and uric acid lowering therapy (35.0% to 24.1%) also declined, while calcium supplementation increased before dialysis initiation and then stabilized thereafter (Fig. 1). Vitamin D supplementation and phosphate binders increased consistently before and after dialysis (Fig. 1). Finally, for management of alimentary tract disorders, proton pump inhibitors use increased before dialysis and then stabilized as laxative use in HD patients. Trends in drug use profiles were generally similar across sex and age groups, with some differences in prevalence observed. Over the study period (2010–2019), psychotropic and calcium supplementation use declined, while analgesic use increased relatively. Conclusion In France, dialysis initiation in older patients is associated with changes in the prevalence of dialysis-related drugs, and stable prevalence of non-dialysis-related drug classes. Dialysis initiation is a critical period for drug management, requiring nephrologist oversight and nurse or pharmacist support.

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.