Prescribing patterns in greek hemodialysis patients: a multicenter pharmacoepidemiology study

Abstract Background and Aims The aim of the study is to investigate the prescribing patterns and polypharmacy in Greek hemodialysis patients and make comparisons between renal units. Polypharmacy and hyperpolypharmacy emerged as a concerning problem, that affects patient's adherence, causes drug-drug interactions, adverse drug events, increases morbidity and economically strains the health system. Patients in Europe, are prescribed on average 10–12 drugs despite recommendations on polypharmacy. Method This is a multicenter retrospective study (2018-2021), in Northeastern Greece, of 270 patients (male = 168, female = 102) with mean age of 63.8±15 years and median dialysis duration of 45(18-96) months. The medications and laboratory values were documented for a period of 12 months, provided that there were no major changes on their therapy that time. The 4 public health dialysis units participating on the survey, were classified as secondary (179 patients) and tertiary care (91 patients) depending on the bed capacity (>600) and the availability of health services. Statistical analysis was conducted using SPSS ver26. Results The mean number of prescribed medications was 10.4 (SD 2.9, range 2–20). Of the participants, 97.4% were experiencing polypharmacy (≥5 medications per person) and 62.6% hyperpolypharmacy (≥10 medications). The average number of prescribed medications in tertiary care was substantially lower comparing with secondary care (mean: 8,7 vs 11,3, p<0.001). The difference in the mean number, remained significant even when the result was adjusted for age, gender, cardiovascular disease, primary disease and dialysis duration. Notably, despite the fewer medications, there was no statistically significant difference between the two groups, in achieving the most recent Kidney Disease Improving Global Outcomes (KDIGO) guidelines for URR (Urea Ruction Ratio), renal mineral bone disease and renal anemia (chi-sqaure, p>0.05 for all variables). The most frequently prescribed group of medications were EPO analogues (87%), Vitamin D supplements (83%), Proton Pump Inhibitors (68%), β-blockers (56%), Antiplatelets (45%) and Loop diuretics (37%). It is important to note the alarming number of patients receiving medication for mental illness (35.2%), mainly benzodiazepines (26%), with women to be more vulnerable (42.2% vs 30.1%, OR:1.63). Conclusion This study reports that Greek prescribing practices follow the same worrisome patterns as other European countries. Rural hospitals appear to prescribe more drugs than tertiary facilities.