Medication Burden and Adverse Cardiovascular Events and Death in Patients Treated with Maintenance Hemodialysis: A Nationwide Cohort Study

ied to investigate the prognostic implications of medication burden regarding adverse outcomes in patients with end-stage kidney disease with maintenance hemodialysis. Methods We analyzed 26,690 patients receiving maintenance hemodialysis who participated in the Periodic Hemodialysis Quality Assessment conducted by the Health Insurance Review and Assessment Service. The exposure of interest was the number of routinely prescribed oral medications. The main outcome was a composite of non-fatal cardiovascular events (non-fatal myocardial infarction, coronary revascularization, non-fatal stroke, or hospitalization for heart failure) or all-cause death (major adverse cardiac and cerebrovascular events). The secondary outcomes were the individual components of the primary outcome. Results During a follow-up period of 146,749 person-years (median, 6.0 years), major adverse cardiac and cerebrovascular events occurred in 17,573 (59.2%) patients. Higher medication burden was associated with progressively higher incidence of major adverse cardiac and cerebrovascular events (84.7, 107.2, 130.2, and 168.9 events per 1000 person-years in Q1–Q4, respectively). In a multivariable Cox proportional hazard model, the adjusted hazard ratios (95% confidence intervals) for the second, third, and highest quartiles were 1.05 (1.00–1.10), 1.12 (1.07–1.17), and 1.27 (1.21–1.33), respectively, compared with the lowest quartile. In continuous modeling, each increase in the number of medication was associated with a 1.03-fold (95% confidence interval 1.03–1.04) higher risk of the primary outcome. Conclusion A high medication burden was independently associated with higher risk of adverse cardiovascular outcomes and all-cause death in patients receiving maintenance hemodialysis. These findings suggest that a high medication burden could be a useful indicator of adverse clinical outcomes in patients undergoing hemodialysis. Copyright © 2024 by the American Society of Nephrology...