Multimorbidity patterns, polypharmacy and their association with liver and kidney abnormalities in people over 65 years of age: a longitudinal study.
Por:
Villén N, Guisado-Clavero M, Fernández-Bertolín S, Troncoso-Mariño A, Foguet-Boreu Q, Amado E, Pons-Vigués M, Roso-Llorach A and Violán C
Publicada:
12 jun 2020
Ahead of Print:
12 jun 2020
Resumen:
BACKGROUND: The implementation of individual clinical practice guidelines in patients with multimorbidity often results in polypharmacy. Our aim was to analyse medication use according to longitudinal multimorbidity patterns (MP) and determine during a 5-year period (2012-16) which MP are associated with abnormal liver and kidney function in primary care patients over 65 years of age living in Catalonia. METHODS: Design: Longitudinal study (years 2012 to 2016) based on the electronic health records contained in Information System for Research in Primary Care database of the Catalan Institute of Health (SIDIAP). VARIABLES: age, sex, MP, medication and polypharmacy (drug exposure obtained from the Pharmacy Invoice Registry). Medicines were classified in accordance with the Anatomical Therapeutic Chemical Classification System (ATC). Glomerular filtration rate was used to determine abnormal kidney function, and serum levels of alkaline phosphatase, alanine transaminase and gamma-glutamyl transpeptidase were used to diagnose abnormal liver function. STATISTICS: For medication use in MP, we calculated annual mean packages of each drug in each MP, and observed/expected ratios were obtained by dividing mean packages in the cluster by mean packages of the same drug in the overall population. Logistic regression models were fitted to estimate the association between MP at baseline and abnormal kidney and liver function tests during follow up. RESULTS: Nine hundred sixteen thousand six hundred nineteen patients were included, and 743,827 completed the follow up. We identified one polypharmacy profile per MP, and concluded that the most prescribed drugs in each pattern corresponded to the diseases overrepresented in that specific MP. The median of drugs ranged from 3 (Cluster 1 - Non-Specific) to 8 (Cluster 10 - Multisystem Pattern). Abnormal kidney function was most commonly observed in the Cluster 4 - Cardio-Circulatory and Renal (Odds Ratio [OR] 2.19; Confidence interval [CI] 95% 2.15-2.23) and Cluster 3 - Minority Metabolic Autoimmune-Inflammatory (OR 2.16; CI 95% 2.12-2.20) MP. A higher risk of abnormal liver function was observed in the Cluster 8 - Digestive (OR 3.39; CI 95% 3.30-3.49), and Cluster 4 - Cardio-Circulatory and Renal (OR 1.96; CI 95% 1.91-2.02) MP. CONCLUSIONS: A higher risk of abnormal kidney and liver function was observed in specific MP. The long-term characterisation of MP and polypharmacy illustrates the burden of chronic multimorbidity and polypharmacy in the elderly population.
Filiaciones:
Villén N:
Àrea del Medicament i Servei de Farmàcia, Gerencia Territorial de Barcelona, Institut Català de la Salut, Barcelona, Spain
Methodology of Biomedical Research and Public Health, Department of Pediatrics, Obstetrics and Gynecology, and Preventive Medicine and Public Health, Universitat Autònoma de Barcelona, Barcelona, Spain
Guisado-Clavero M:
Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Bellaterra, Spain
Fernández-Bertolín S:
Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Bellaterra, Spain
Troncoso-Mariño A:
Àrea del Medicament i Servei de Farmàcia, Gerencia Territorial de Barcelona, Institut Català de la Salut, Barcelona, Spain
Foguet-Boreu Q:
Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Bellaterra, Spain
Department of Psychiatry, Vic University Hospital, Vic, Spain
Amado E:
Àrea del Medicament i Servei de Farmàcia, Gerencia Territorial de Barcelona, Institut Català de la Salut, Barcelona, Spain
Pons-Vigués M:
Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Bellaterra, Spain
Àrea de Serveis Assistencials. Servei Català de la Salut, Barcelona, Spain
Roso-Llorach A:
Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain.
Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Bellaterra, Spain.
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