Patterns in blood pressure medication use in US incident dialysis patients over the first 6 months

BMC Nephrology - Tập 14 - Trang 1-11 - 2013
Wendy L St Peter1,2, Stephen M Sozio3,4, Tariq Shafi3,4, Patti L Ephraim4,5, Jason Luly6, Aidan McDermott7, Karen Bandeen-Roche7, Klemens B Meyer8, Deidra C Crews3,4, Julia J Scialla9, Dana C Miskulin8, Navdeep Tangri10, Bernard G Jaar3,4,11,12, Wieneke M Michels4,6,13, Albert W Wu5,14,15,16, L Ebony Boulware4,5,6
1University of Minnesota College of Pharmacy, Minneapolis, USA
2Chronic Disease Research Group, Minneapolis Medical Research Foundation, Minneapolis, USA
3Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, USA
4Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, USA
5Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA;
6Division of General Internal Medicine, Johns University Hopkins School of Medicine, Baltimore, USA
7Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
8Division of Nephrology, Tufts University School of Medicine, Boston, USA
9Department of Medicine, University of Miami Miller School of Medicine, Miami, USA
10Department of Medicine, Division of Nephrology, Seven Oaks General Hospital, University of Manitoba, Winnipeg, Canada
11Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
12Nephrology Center of Maryland, Baltimore, USA
13Division of Nephrology, Department of Medicine, Academic Medical Center, Amsterdam, the Netherlands
14Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
15Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
16Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, USA

Tóm tắt

Several observational studies have evaluated the effect of a single exposure window with blood pressure (BP) medications on outcomes in incident dialysis patients, but whether BP medication prescription patterns remain stable or a single exposure window design is adequate to evaluate effect on outcomes is unclear. We described patterns of BP medication prescription over 6 months after dialysis initiation in hemodialysis and peritoneal dialysis patients, stratified by cardiovascular comorbidity, diabetes, and other patient characteristics. The cohort included 13,072 adult patients (12,159 hemodialysis, 913 peritoneal dialysis) who initiated dialysis in Dialysis Clinic, Inc., facilities January 1, 2003-June 30, 2008, and remained on the original modality for at least 6 months. We evaluated monthly patterns in BP medication prescription over 6 months and at 12 and 24 months after initiation. Prescription patterns varied by dialysis modality over the first 6 months; substantial proportions of patients with prescriptions for beta-blockers, renin angiotensin system agents, and dihydropyridine calcium channel blockers in month 6 no longer had prescriptions for these medications by month 24. Prescription of specific medication classes varied by comorbidity, race/ethnicity, and age, but little by sex. The mean number of medications was 2.5 at month 6 in hemodialysis and peritoneal dialysis cohorts. This study evaluates BP medication patterns in both hemodialysis and peritoneal dialysis patients over the first 6 months of dialysis. Our findings highlight the challenges of assessing comparative effectiveness of a single BP medication class in dialysis patients. Longitudinal designs should be used to account for changes in BP medication management over time, and designs that incorporate common combinations should be considered.

Tài liệu tham khảo

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