Hospitalizations Increase Medication Complexity in Patients on Long-Term Hemodialysis

Background: End stage kidney disease (ESKD) patients are medically complex with significant polypharmacy. Medication regimen complexity index (MRCI) is a validated, non-disease-specific tool that considers medication form, frequency, and special instructions. MRCI has not been well studied in this population. We compared pre and post hospitalization MRCI in hemodialysis (HD) patients. Methods: This retrospective study included 60 adult patients on HD admitted to a large academic medical center. Data collection included: age; dialysis vintage; hospital length of stay (LOS); admission diagnosis; number of prescriptions and MRCI before hospitalization and at discharge (excluding medications administered at the dialysis clinic). Paired t-test was used to analyze the number of prescriptions and MRCI, comparing pre and post hospitalization. We also examined age, vintage, and LOS for association with MRCI. Results: Mean age was 63.0 ± 12.7 years, median vintage 5 years (interquartile range 2 to 7), and median LOS 10 days (interquartile range 3 to 19). MRCI was significantly higher post-hospitalization than pre-hospitalization (mean 52.7 versus 48.7; p=0.008). Total medication complexity was driven by both an increase in the number of prescriptions as well as an increase in average prescription complexity (see Table 1). We found no association between pre-hospital MRCI with age, vintage, or LOS. Conclusion: In ESKD patients on HD, there is a significant increase in MRCI post-hospitalization that is driven by an increase in number of medications as well as average medication complexity. Whether higher MRCI in this population is associated with more adverse outcomes, such as mortality or increased hospital readmissions, remains unanswered.Table 1: Pre and post hospitalization MRCI and prescription analysis