Polypharmacy in Renal Transplant Recipients
Ghulam Rana1, Mohamed Ahmed1, William Mckane1.
1Sheffield Kidney Institue , Sheffield Teaching Hospital’s NHS Foundation Trust, Sheffield , United Kingdom
Introduction: Polypharmacy and medication complexity are risk factors for non-adherence in chronic diseases. This study is the first longitudinal analysis of of medication complexity in patients pre/post transplantation.
Methods: Retrospective analysis of incident transplant recepients in a single centre, 2014. Data source: prospectively managed electronic patient and prescribing record. Exclusion: on of death, graft failure or transfer in the first year. Immunosuppresion (IS): modified Symphony regimen. Medication burden was assessed (0, 1, 6, 12 months) and complexity was calculated (Medication Regimen Complexity Index, MRCI).
Results: 53 patients ( 68% male, 30% LD, 15% regraft) with mean age 51∓14 and Charlson Comorbidity Index (CCI) 2.8 ∓1.0 were analysed (all data are mean ∓ SD):
| 0 (pre-txp) | 1 month | 6 month | 12 month | |
| Total medications | 8.7 ± 3.9 | 11.6 ± 2.9 | 9.6 ± 2.6 | 9.4 ± 3.2 |
| Total pill burden | 16.7 ± 9.3 | 27.5 ∓ 8.2 | 16.9 ∓ 5.2 | 16.3 ∓ 5.2 |
| IS medications | 2.8 ∓ 0.5 | 2.7 ∓ 0.5 | 2.7 ∓ 0.5 | |
| IS pill burden | 11.2 ∓ 2.6 | 7.4 ∓ 2.4 | 7.0 ∓ 2.4 | |
| CV pill burden | 4.0 ± 3.0 | 3.0 ∓ 1.4 | ||
| CKD-MBD* pill burden | 4.4 ± 3.3 | 0.9 ∓ 0.9 | ||
| MRCI | 20.6 ± 10.2 | 25.8 ∓ 8.6 |
The MRCI was high pre-transplant and significantly higher at 12 months (p<0.001). The Pill burden peaked at 1 month due to higher IS burden, CMV/PCP prophylaxis and drugs for symptom control. The MRCI at 12 month was significantly higher in DM (p=0.014), and CCI >2 (p=0.005) but was not associated with age, gender, CMV, serostatus, DR mismatch, donor type or pre-transplant HD. If once daily tacrolimus had been used, the potential reduction in MRCI was negligible (-1.4, p=0.38).
Discussion: The MRCI in CKD5 and transplant patients is exceptionally high. Published mean MRCI for other chronic diseases include DM 6.3 and HIV 4.9. This study does not provide direct evidence of a link between MRCI and non adherence in transplantation but evidence in other diseases makes this likley. Studies are needed to link medication complexity to graft outcome and to deivse interventions to reduce MRCI.
