MJUN1, L SUKKAR1,2, M JARDINE1, B TALBOT1, A CASS3, C REITH4, R WALKER5, M GALLAGHER1,2
1The George Institute For Global Health, Newtown, Australia, 2Sydney School of Public Health, The University of Sydney, Camperdown, Australia, 3Menzies School of Health Research, Darwin, Australia, 4Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford , Oxford, UK, 5Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
Aim:To describe baseline medication use in CKD patients of the SHARP-ER study.
Background:Medication use of patients with CKD in Australia is accepted as high, but systematic, national data has not been available. The Pharmaceutical Benefits Scheme (PBS) offers a novel means of real-world assessments medication use patterns in CKD.
Methods:Australian participants from the SHARP-ER study, a 5-year post-trial (2010-2015) extended follow-up of SHARP participants known to be alive at the end of the trial (study of cholesterol-lowering in CKD) in ANZ and Malaysia, were linked to the PBS. Prescription medication dispensation in the year prior to SHARP-ER baseline, defined as the first study visit which occurred 1.5-2 years following the final SHARP visit, were obtained. We examined medication use (receipt of ≥1 prescription) from any of the following medication groups: cardioprotective (blood pressure-lowering, lipid-lowering, glucose-lowering, anticoagulant, antiplatelet, anaemia treatment), anti-infective, immunosuppressant, proton pump inhibitor (PPI) treatment and others.
Results: Of 304 participants, 86 (28.3) were on maintenance dialysis at baseline. Overall, there were 11,272 unique prescriptions dispensed in the year prior to baseline which included those for cardioprotective(58.4%), anti-infective(9.6%), immunosuppressive(7.6%), PPI(12.6%) treatment and others(11.6%). On average, patients were prescribed 6 different medications (IQR:4-8). The distributions of medication use across the medication groups in the 304 participants were: 92.8%, 68.4%. 25.3%, 53.3% and 54.3%, respectively. The proportion of patients receiving ≥3 medication groups was significantly higher among those on dialysis (76.7% vs. 64.7%;p=0.04) compared with non-dialysis CKD patients.
Conclusions:PBS data in patients with moderate-to-severe CKD suggests a high medication burden primarily directed at cardiovascular risk mitigation. Further longitudinal assessments of cardioprotective and anti-infective medication use according to patient characteristics are needed.
Min Jun is a Senior Research Fellow at the George Institute for Global Health and Scientia Fellow at UNSW Sydney.