Introduction: Dialysis patients are at high risk for polypharmacy with many comorbidities and complications from their disease and treatment. The prescribing patterns and burden of polypharmacy in dialysis patients, and specifically the difference between hemodialysis and peritoneal dialysis prescribing are not well characterized. The objectives of this study were to review prescribing patterns for dialysis patients, to analyse any differences between hemodialysis (HD) and peritoneal dialysis (PD), and to identify potential opportunities for deprescription.

Methods: We completed a retrospective analysis of demographic and medication data for patients who were on chronic dialysis from June 3rd 2015 to October 1st 2015. Both prescription and non-prescription medications were collected. Medications were classified by indication - (1) renal complications (2) cardiovascular (CV)  (3) diabetes (DM) or (4) symptom management. Medications were also classified as a “Potentially Inappropriate Medications”(PIMs) or not. Ethics approval was granted from the University of British Columbia Research and Ethics Board. 

Results: 3017 patients metinclusion/exclusion criteria (2,243 HD, 774 PD). The mean (SD) age was 66.2 (14.8) years. The HD group had more patients over 80 years old (22.1% vs 12.5%) and more patients with DM and CV disease. The mean number (SD) of prescribed medications was 17.71 (5.72) with more medications in the HD group versus the PD group. The mean number of medications increased with dialysis vintage in both groups. HD patients were on more medications for renal complication and symptom management than PD patients. . Patients on HD were prescribed more PIMs than patients on PD (5.37 (2.83) vs 4.02 (2.37)). 

Conclusion: This is the first study to review and characterize both the prescription and non-prescription medication use in HD patients and PD patients. Patients in both groups experience polypharmacy and prescription of PIMs. Patients on HD receive more overall medications and more PIMs. There are opportunities for future systematic and patient informed deprescription initiatives in both patient groups.

Prescription patterns in dialysis patients – differences between hemodialysis and peritoneal dialysis and opportunities for deprescription