Risk is greater when patients’ main provider is a nephrologist, not a PCP.


TORONTO—Nearly one third of women with CKD are taking at least five medications, according to researchers.

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The investigators, who are affiliated with the University of Missouri in Kansas City, concluded that increased awareness is needed among clinicians regarding the impact of polypharmacy on women with CKD in outpatient settings in the United States.


Rafia Rasu, PhD, assistant professor of pharmacy practice and assistant professor of nursing and her research assistant Madison Abercrombie analyzed 1,345 patient visits recorded in the National Ambulatory Medical Care Survey (NAMCS) between 1996 and 2003. By using NAMCS patient weights they extrapolated the results to the entire American population.

About one third—31.6%—of the individuals received at least five medications. Fifty-five percent were being cared for by primary-care physicians and 15% by nephrologists. Seventy-nine percent were white.


Compared with women aged 18-34 years, those aged 35-49, 50-64, and 65 and older were 2.5, 4.5, and 4.2 times as likely to be receiving at least five medications, respectively. Furthermore, women whose main health provider was a nephrologist were twice as likely to be receiving at least five medications compared with women whose main doctor was a primary-care physician.


Study findings were reported here at the 2008 annual meeting of the International Society of Pharmacoeconomics and Outcomes Research.


Commenting on the new findings, Daniel W. Coyne, MD, professor of medicine in the department of renal diseases at Washington University School of Medicine in St. Louis, commented that polypharmacy is not necessarily deleterious for patients be-cause they may have numerous ailments that require treatment.


In addition to diabetes, hypertension, and heart disease, CKD patients may have arthritis, asthma, gout, vitamin D deficiency, anemia, and acidosis, to name just a few common diseases that occur with CKD and older age, Dr. Coyne said. Polypharmacy, he added, may present problems with adherence to medication regimens and with drug interactions, but this means that “these high-risk patients need careful evaluation of medications, not necessarily fewer medications.”