Prevalence of polypharmacy and associated adverse health outcomes in adult patients with chronic kidney disease: protocol for a systematic review and meta-analysis

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dc.contributor.authorOkpechi, Ikechi G
dc.contributor.authorTinwala, Mohammed M
dc.contributor.authorMuneer, Shezel
dc.contributor.authorZaidi, Deenaz
dc.contributor.authorYe, Feng
dc.contributor.authorHamonic, Laura N
dc.contributor.authorKhan, Maryam
dc.contributor.authorSultana, Naima
dc.contributor.authorBrimble, Scott
dc.contributor.authorGrill, Allan
dc.contributor.authorKlarenbach, Scott
dc.contributor.authorLindeman, Cliff
dc.contributor.authorMolnar, Amber
dc.contributor.authorNitsch, Dorothea
dc.contributor.authorRonksley, Paul
dc.contributor.authorShojai, Soroush
dc.contributor.authorSoos, Boglarka
dc.contributor.authorTangri, Navdeep
dc.contributor.authorThompson, Stephanie
dc.contributor.authorTuot, Delphine
dc.contributor.authorDrummond, Neil
dc.contributor.authorMangin, Dee
dc.contributor.authorBello, Aminu K
dc.date.accessioned2021-10-11T09:25:28Z
dc.date.available2021-10-11T09:25:28Z
dc.date.issued2021-07-04
dc.date.updated2021-07-11T03:16:38Z
dc.description.abstractBackground Polypharmacy, often defined as the concomitant use of ≥ 5 medications, has been identified as a significant global public health threat. Aging and multimorbidity are key drivers of polypharmacy and have been linked to a broad range of adverse health outcomes and mortality. Patients with chronic kidney disease (CKD) are particularly at high risk of polypharmacy and use of potentially inappropriate medications given the numerous risk factors and complications associated with CKD. The aim of this systematic review will be to assess the prevalence of polypharmacy among adult patients with CKD, and the potential association between polypharmacy and adverse health outcomes within this population. Methods/design We will search empirical databases such as MEDLINE, Embase, Cochrane Library, CINAHL, Web of Science, and PsycINFO and grey literature from inception onwards (with no language restrictions) for observational studies (e.g., cross-sectional or cohort studies) reporting the prevalence of polypharmacy in adult patients with CKD (all stages including dialysis). Two reviewers will independently screen all citations, full-text articles, and extract data. Potential conflicts will be resolved through discussion. The study methodological quality will be appraised using an appropriate tool. The primary outcome will be the prevalence of polypharmacy. Secondary outcomes will include any adverse health outcomes (e.g., worsening kidney function) in association with polypharmacy. If appropriate, we will conduct random effects meta-analysis of observational data to summarize the pooled prevalence of polypharmacy and the associations between polypharmacy and adverse outcomes. Statistical heterogeneity will be estimated using Cochran’s Q and I2 index. Additional analyses will be conducted to explore the potential sources of heterogeneity (e.g., sex, kidney replacement therapy, multimorbidity). Discussion Given that polypharmacy is a major and a growing public health issue, our findings will highlight the prevalence of polypharmacy, hazards associated with it, and medication thresholds associated with adverse outcomes in patients with CKD. Our study will also draw attention to the prognostic importance of improving medication practices as a key priority area to help minimize the use of inappropriate medications in patients with CKD. Systematic review registration PROSPERO registration number: [ CRD42020206514 ].en_US
dc.identifier.apacitationOkpechi, I. G., Tinwala, M. M., Muneer, S., Zaidi, D., Ye, F., Hamonic, L. N., ... Bello, A. K. (2021). Prevalence of polypharmacy and associated adverse health outcomes in adult patients with chronic kidney disease: protocol for a systematic review and meta-analysis. <i>Systematic Reviews</i>, 10(1), 198. http://hdl.handle.net/11427/35150en_ZA
dc.identifier.chicagocitationOkpechi, Ikechi G, Mohammed M Tinwala, Shezel Muneer, Deenaz Zaidi, Feng Ye, Laura N Hamonic, Maryam Khan, et al "Prevalence of polypharmacy and associated adverse health outcomes in adult patients with chronic kidney disease: protocol for a systematic review and meta-analysis." <i>Systematic Reviews</i> 10, 1. (2021): 198. http://hdl.handle.net/11427/35150en_ZA
dc.identifier.citationOkpechi, I.G., Tinwala, M.M., Muneer, S., Zaidi, D., Ye, F., Hamonic, L.N., Khan, M. & Sultana, N. et al. 2021. Prevalence of polypharmacy and associated adverse health outcomes in adult patients with chronic kidney disease: protocol for a systematic review and meta-analysis. <i>Systematic Reviews.</i> 10(1):198. http://hdl.handle.net/11427/35150en_ZA
dc.identifier.ris TY - Journal Article AU - Okpechi, Ikechi G AU - Tinwala, Mohammed M AU - Muneer, Shezel AU - Zaidi, Deenaz AU - Ye, Feng AU - Hamonic, Laura N AU - Khan, Maryam AU - Sultana, Naima AU - Brimble, Scott AU - Grill, Allan AU - Klarenbach, Scott AU - Lindeman, Cliff AU - Molnar, Amber AU - Nitsch, Dorothea AU - Ronksley, Paul AU - Shojai, Soroush AU - Soos, Boglarka AU - Tangri, Navdeep AU - Thompson, Stephanie AU - Tuot, Delphine AU - Drummond, Neil AU - Mangin, Dee AU - Bello, Aminu K AB - Background Polypharmacy, often defined as the concomitant use of ≥ 5 medications, has been identified as a significant global public health threat. Aging and multimorbidity are key drivers of polypharmacy and have been linked to a broad range of adverse health outcomes and mortality. Patients with chronic kidney disease (CKD) are particularly at high risk of polypharmacy and use of potentially inappropriate medications given the numerous risk factors and complications associated with CKD. The aim of this systematic review will be to assess the prevalence of polypharmacy among adult patients with CKD, and the potential association between polypharmacy and adverse health outcomes within this population. Methods/design We will search empirical databases such as MEDLINE, Embase, Cochrane Library, CINAHL, Web of Science, and PsycINFO and grey literature from inception onwards (with no language restrictions) for observational studies (e.g., cross-sectional or cohort studies) reporting the prevalence of polypharmacy in adult patients with CKD (all stages including dialysis). Two reviewers will independently screen all citations, full-text articles, and extract data. Potential conflicts will be resolved through discussion. The study methodological quality will be appraised using an appropriate tool. The primary outcome will be the prevalence of polypharmacy. Secondary outcomes will include any adverse health outcomes (e.g., worsening kidney function) in association with polypharmacy. If appropriate, we will conduct random effects meta-analysis of observational data to summarize the pooled prevalence of polypharmacy and the associations between polypharmacy and adverse outcomes. Statistical heterogeneity will be estimated using Cochran’s Q and I2 index. Additional analyses will be conducted to explore the potential sources of heterogeneity (e.g., sex, kidney replacement therapy, multimorbidity). Discussion Given that polypharmacy is a major and a growing public health issue, our findings will highlight the prevalence of polypharmacy, hazards associated with it, and medication thresholds associated with adverse outcomes in patients with CKD. Our study will also draw attention to the prognostic importance of improving medication practices as a key priority area to help minimize the use of inappropriate medications in patients with CKD. Systematic review registration PROSPERO registration number: [ CRD42020206514 ]. DA - 2021-07-04 DB - OpenUCT DP - University of Cape Town IS - 1 J1 - Systematic Reviews KW - CKD KW - Polypharmacy KW - Elderly KW - Multimorbidity KW - Adverse effects KW - Prescriptions LK - https://open.uct.ac.za PY - 2021 T1 - Prevalence of polypharmacy and associated adverse health outcomes in adult patients with chronic kidney disease: protocol for a systematic review and meta-analysis TI - Prevalence of polypharmacy and associated adverse health outcomes in adult patients with chronic kidney disease: protocol for a systematic review and meta-analysis UR - http://hdl.handle.net/11427/35150 ER - en_ZA
dc.identifier.urihttps://doi.org/10.1186/s13643-021-01752-z
dc.identifier.urihttp://hdl.handle.net/11427/35150
dc.identifier.vancouvercitationOkpechi IG, Tinwala MM, Muneer S, Zaidi D, Ye F, Hamonic LN, et al. Prevalence of polypharmacy and associated adverse health outcomes in adult patients with chronic kidney disease: protocol for a systematic review and meta-analysis. Systematic Reviews. 2021;10(1):198. http://hdl.handle.net/11427/35150.en_ZA
dc.language.isoenen_US
dc.language.rfc3066en
dc.publisher.departmentDivision of Nephrology and Hypertensionen_US
dc.publisher.facultyFaculty of Health Sciencesen_US
dc.rights.holderThe Author(s)
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/en_US
dc.sourceSystematic Reviewsen_US
dc.source.journalissue1en_US
dc.source.journalvolume10en_US
dc.source.pagination198en_US
dc.source.urihttps://systematicreviewsjournal.biomedcentral.com/
dc.subjectCKDen_US
dc.subjectPolypharmacyen_US
dc.subjectElderlyen_US
dc.subjectMultimorbidityen_US
dc.subjectAdverse effectsen_US
dc.subjectPrescriptionsen_US
dc.titlePrevalence of polypharmacy and associated adverse health outcomes in adult patients with chronic kidney disease: protocol for a systematic review and meta-analysisen_US
dc.typeJournal Articleen_US
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