Supplementary Material for: Polypharmacy and Frailty among Hemodialysis Patients

Background: Both polypharmacy and frailty are highly prevalent among the patients on hemodialysis and associated with adverse outcomes; however, little is known about the association between them. Methods: We examined 337 patients enrolled in the ACTIVE/ADIPOSE dialysis cohort study between 2009 and 2011. The number of prescribed medications and frailty were assessed at baseline, 12, and 24 months. Frailty was defined based upon the Fried’s frailty phenotype. We used logistic regression with generalized estimating equations to model the association of the number of medications and frailty at baseline and over time. A competing-risk regression analysis was also used to assess the association between the number of medications and incidence of frailty. Results: The mean number of medications was 10 ± 5, and 94 patients (28%) were frail at baseline. Patients taking >11 medications showed higher odds for frailty than the patients taking fewer than 8 medications (OR 1.54, 95% CI 1.05–2.26). During the 2-year of follow-up, 87 patients developed frailty among those who were nonfrail at baseline. Compared with the patients taking fewer than 8 medications, the incidence of frailty was approximately 2-fold in those taking >11 medications (sub-distribution hazard ratio 2.15, 95% CI 1.32–3.48). Conclusions: Using a higher number of medications was associated with frailty and the incidence of frailty among hemodialysis patients. Minimizing polypharmacy may reduce the incidence and prevalence of frailty among dialysis patients.背景：血液透析（hemodialysis）患者中，多重用药（polypharmacy）与衰弱（frailty）均具有极高的患病率，且二者均与不良预后相关；但目前对二者之间的关联尚所知甚少。 方法：本研究纳入2009至2011年间入组ACTIVE/ADIPOSE透析队列研究的337例患者。分别于基线（baseline）、12个月及24个月时评估患者的处方药物数量与衰弱状态。衰弱的判定基于Fried衰弱表型（Fried’s frailty phenotype）。本研究采用结合广义估计方程（generalized estimating equations, GEE）的逻辑回归（logistic regression）模型，分析基线及随访全程中处方药物数量与衰弱的关联；同时采用竞争风险回归（competing-risk regression）分析，评估处方药物数量与衰弱发生率之间的关联。 结果：研究对象的平均处方药物数量为10±5，基线时共有94例（28%）患者存在衰弱。与服用药物少于8种的患者相比，服用药物超过11种的患者发生衰弱的比值比（Odds Ratio, OR）更高（OR=1.54，95%置信区间（Confidence Interval, CI）：1.05~2.26）。在2年随访期间，基线时无衰弱的患者中共计87例新发衰弱。与服用药物少于8种的患者相比，服用药物超过11种的患者衰弱发生率约为其2倍（亚分布风险比（sub-distribution hazard ratio）=2.15，95%CI：1.32~3.48）。 结论：血液透析患者中，更高的处方药物数量与衰弱及衰弱发生率显著相关。减少多重用药或可降低透析患者衰弱的发生率与患病率。