Medication Burden and Adverse Cardiovascular Events and Death in Patients Treated with Maintenance Hemodialysis

Key Points A higher medication burden was associated with a higher risk of adverse events in patients receiving maintenance hemodialysis. Medication burden can serve as a clinically relevant risk indicator for cardiovascular events and all-cause death in patients on maintenance hemodialysis. Background A high medication burden is associated with adverse outcomes. Although patients with ESKD have a substantial medication burden, the relationship between the number of medications in use and clinical outcomes in these patients remains unclear. Hence, this study aimed to investigate the prognostic implications of medication burden regarding adverse outcomes in patients with ESKD on maintenance hemodialysis. Methods We analyzed 29,690 patients receiving maintenance hemodialysis who participated in the Periodic Hemodialysis Quality Assessment conducted by the Health Insurance Review and Assessment Service. The exposure of interest was the number of routinely prescribed oral medications. The main outcome was a composite of nonfatal cardiovascular events (nonfatal myocardial infarction, coronary revascularization, nonfatal stroke, or hospitalization for heart failure) or all-cause death (major adverse cardiac and cerebrovascular events [MACCEs]). The secondary outcomes were the individual components of the primary outcome. Results During a follow-up period of 146,749 person-years (median, 6.0 years), MACCEs occurred in 17,573 patients (59.2%). Higher medication burden was associated with progressively higher incidence of MACCEs (84.7, 107.2, 130.2, and 168.9 events per 1000 person-years in Q1–Q4, respectively). In a multivariable Cox proportional hazard model, the adjusted hazard ratios (95% confidence intervals) for the second, third, and highest quartiles were 1.05 (1.00 to 1.10), 1.12 (1.07 to 1.17), and 1.27 (1.21 to 1.33), respectively, compared with the lowest quartile. In continuous modeling, each increase in the number of medication was associated with a 1.03-fold (95% confidence interval, 1.03 to 1.04) higher risk of the primary outcome. Conclusion A high medication burden was independently associated with higher risk of adverse cardiovascular outcomes and all-cause death in patients receiving maintenance hemodialysis. These findings suggest that a high medication burden could be a useful indicator of adverse clinical outcomes in patients undergoing hemodialysis.