Relationship Between Polypharmacy And Renal Injury In Elderly Patients With Multimorbidity

Objective:Chronic non-communicable diseases have become a global public problem,as one of them,chronic kidney disease(CKD)is a risk factor for cardiovascular diseases and even death,with a high incidence and serious complications.The number of drugs increases with the prevalence of multimorbidity in the elderly,leading to polypharmacy which causes a series of problems such as adverse drug reactions and geriatric syndromes.Studies abroad have found that polypharmacy causes a decline in renal function,leads to renal injury,and even become a risk factor for the development of CKD.At present,domestic studies have rarely focused on the relationship between them.Therefore,this study will explore the relationship between polypharmacy and renal injury in elderly patients with multimorbidity aged 65 years or over.Methods:A total of 342 elderly patients aged 65 years or over who were admitted to the Affiliated Hospital of Qingdao University from June 2018 to June 2019 were enrolled in this study,and their diseases and oral drugs were recorded.According to the guidelines of Kidney Disease:Improving Global Outcomes(KDIGO)and Kidney Disease Outcomes Quality Initiative(K/DOQI),renal injury was defined as estimated glomerular filtration rate(eGFR)<60ml/min/1.73m~2,and the subjects were divided into renal injury group(n=122)and non-renal injury group(n=220).Basic clinical data including age,gender,height,weight,body mass index(BMI),systolic blood pressure(SBP),diastolic blood pressure(DBP),previous medical history(hypertension,coronary heart disease,type 2diabetes)and some clinical tests such as hemoglobin(Hb),urea nitrogen(BUN),uric acid(UA),cystatin C(CysC),serum creatinine(SCr)and so on were recorded.The multimorbidity,polypharmacy and so on were compared between the two groups,correlation analysis was performed between clinical indicators and eGFR,and logistic regression analysis model was established to evaluate the relationship between polypharmacy and renal injury in elderly patients.Results:1.Among 342 subjects included in the study,171 were males and 171 were females,aged 65-95 years,with an average age of(75.69±7.65)years.The number of multimorbidities was 2-12,with an average of(4.72±2.02),234 patients(68.4%)had 4 or more chronic diseases.The most common chronic diseases were hypertension(81.6%),coronary heart disease(69.6%),and type 2 diabetes(40.9%).All patients took 1-20 kinds of drugs,with an average of(5.42±2.87).There were 207(60.5%)patients with polypharmacy in the study,100(58.5%)were males,and 107(62.6%)were females.Oral prescription drugs with aspirin(47.1%),isosorbide mononitrate(34.5%),atorvastatin calcium(31.9%),rosuvastatin calcium(25.4%)and trimetazidine(23.4%)were common.A total of 122 patients(35.7%)took traditional Chinese patent medicine,of which 87patients took one.2.Compared with the non-renal injury group,the mean age of the patients with renal injury group was larger,the number of drugs'types was greater,the rate of polypharmacy was higher,the prevalences of hypertension,coronary heart disease and type 2 diabetes were higher(all P<0.05).At the same time,the levels of Hb and eGFR in patients with renal injury group were lower than those in non-renal injury group(both P<0.05),while the levels of BUN,UA,CysC,and SCr were higher(all P<0.05).3.Correlation analysis showed eGFR and age,kinds of drugs,hypertension,coronary heart disease,type 2 diabetes,BUN,UA,CysC,TG were negatively correlated(all P<0.05),and positively correlated with Hb(P<0.05).4.Binary logistic regression analysis showed that after adjusting for factors such as age,previous medical history(hypertension,coronary heart disease,type 2 diabetes),Hb,BUN,UA,polypharmacy was an independent risk factor for renal injury(OR=1.892,95%CI:1.103-3.243;OR=3.311,95%CI:1.357-8.082,P<0.05).Conclusions:Compared with patients in non-renal injury group,patients in renal injury group had a larger number of drugs and a higher rate of polypharmacy.Polypharmacy was negatively related to renal injury significantly,which was a risk factor for it.Elderly patients with multimorbidity and polypharmacy should be monitored for drugs and renal function,evaluated for drug prescriptions and the stage of renal function,and intervened early to delay the onset of CKD.