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Medication regimen complexity and hospital readmission in older adults with chronic kidney disease

Tesfaye, W, Peterson, GM ORCID: 0000-0002-6764-3882, Castelino, RL, McKercher, CM ORCID: 0000-0002-7672-6743, Jose, MD ORCID: 0000-0002-9589-0071, Wimmer, BC ORCID: 0000-0003-3166-7126 and Zaidi, STR ORCID: 0000-0002-2031-1055 2018 , 'Medication regimen complexity and hospital readmission in older adults with chronic kidney disease' , The Annals of Pharmacotherapy, vol. 53, no. 1 , pp. 28-34 , doi: 10.1177/1060028018793419.

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Background: Chronic kidney disease (CKD) is characterized by high rates of hospital admissions and readmissions.However, there is a scarcity of research into medication-related factors predicting such outcomes in this patient group.Objective: To evaluate the effect of medication regimen complexity at hospital discharge on subsequent readmissionsand their timing in older adults with CKD. Methods: This was a 12-month retrospective cohort study of 204 older (⩾65years) CKD patients in an Australian tertiary care hospital. Medication regimen complexity was quantified using the 65-item medication regimen complexity index (MRCI). The outcomes were the occurrence of readmission in 30 days andtime to readmission within 12 months. Logistic regression was used to identify factors predicting 30-day readmission, anda competing risks proportional subdistribution hazard model, accounting for deaths, was used for factors predicting time toreadmission. Results: Overall, 50 (24%) patients, predominantly men (72%), were readmitted within 30 days of follow-up.MRCI was not significantly associated with 30-day readmission (odds ratio [OR] = 1.27; 95% CI = 0.94-1.73). The median(interquartile range) time to readmission within 12 months was 145 (31-365) days. On a multivariate analysis, a 10-unitincrease in MRCI was associated with a shorter time to readmission within 12 months (subdistribution HR = 1.18; 95% CI= 1.01-1.36). Conclusion and Relevance: Medication regimen complexity was not significantly associated with 30-dayreadmission; however, it was associated with a significantly shorter time to 12-month readmission in older CKD patients.This finding highlights the importance of medication regimen complexity as a potential target for medical interventions toreduce readmission risks.

Item Type: Article
Authors/Creators:Tesfaye, W and Peterson, GM and Castelino, RL and McKercher, CM and Jose, MD and Wimmer, BC and Zaidi, STR
Keywords: medication use, medication regimen complexity, chronic kidney disease, hospital readmission, elderly, predictors
Journal or Publication Title: The Annals of Pharmacotherapy
Publisher: Harvey Whitney Books Co
ISSN: 1060-0280
DOI / ID Number: 10.1177/1060028018793419
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Copyright 2018 The Authors

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