@article{7a8bbbdd9e4e475fb07597ddad50966a,
title = "Patterns in blood pressure medication use in US incident dialysis patients over the first 6 months",
abstract = "Background: Several observational studies have evaluated the effect of a single exposure window with blood pressure (BP) medications on outcomes in incident dialysis patients, but whether BP medication prescription patterns remain stable or a single exposure window design is adequate to evaluate effect on outcomes is unclear. Methods. We described patterns of BP medication prescription over 6 months after dialysis initiation in hemodialysis and peritoneal dialysis patients, stratified by cardiovascular comorbidity, diabetes, and other patient characteristics. The cohort included 13,072 adult patients (12,159 hemodialysis, 913 peritoneal dialysis) who initiated dialysis in Dialysis Clinic, Inc., facilities January 1, 2003-June 30, 2008, and remained on the original modality for at least 6 months. We evaluated monthly patterns in BP medication prescription over 6 months and at 12 and 24 months after initiation. Results: Prescription patterns varied by dialysis modality over the first 6 months; substantial proportions of patients with prescriptions for beta-blockers, renin angiotensin system agents, and dihydropyridine calcium channel blockers in month 6 no longer had prescriptions for these medications by month 24. Prescription of specific medication classes varied by comorbidity, race/ethnicity, and age, but little by sex. The mean number of medications was 2.5 at month 6 in hemodialysis and peritoneal dialysis cohorts. Conclusions: This study evaluates BP medication patterns in both hemodialysis and peritoneal dialysis patients over the first 6 months of dialysis. Our findings highlight the challenges of assessing comparative effectiveness of a single BP medication class in dialysis patients. Longitudinal designs should be used to account for changes in BP medication management over time, and designs that incorporate common combinations should be considered.",
keywords = "Blood pressure medication, Dialysis, Medication use patterns",
author = "{St Peter}, {Wendy L.} and Sozio, {Stephen M.} and Tariq Shafi and Ephraim, {Patti L.} and Jason Luly and Aidan McDermott and Karen Bandeen-Roche and Meyer, {Klemens B.} and Crews, {Deidra C.} and Scialla, {Julia J.} and Miskulin, {Dana C.} and Navdeep Tangri and Jaar, {Bernard G.} and Michels, {Wieneke M.} and Wu, {Albert W.} and {Ebony Boulware}, L.",
note = "Funding Information: The Developing Evidence to Inform Decisions about Effectiveness (DEcIDE) Network Patient Outcomes in ESRD Study was supported by the Agency for Healthcare Research and Quality (AHRQ) contract HHSA290200500341I, Task Order 6. Dr. Shafi was supported by grant K23-DK-083514 from the National Institute for Diabetes, Digestive and Kidney Diseases (NIDDK), Bethesda MD. Dr. Michels was supported by a Postdoctoral Full Fellowship Abroad Grant (KFB 11.005) of the Dutch Kidney Foundation (Nierstichting), Amerstdam, The Netherlands. AHRQ: Identifiable information, on which this report, presentation, or other form of disclosure is based, is confidential and protected by federal law, Section 903(c) of the Public Health Service Act, 42 USC 299a-1(c). Any identifiable information that is knowingly disclosed is disclosed solely for the purpose for which it has been supplied. No identifiable information about any individual supplying the information or described in it will be knowingly disclosed except with the prior consent of that individual. USRDS: The data reported here have been supplied by the United States Renal Data System (USRDS). The interpretation and reporting of these data are the responsibility of the author(s) and in no way should be seen as an official policy or interpretation of the U.S. government. The DEcIDE Network Patient Outcomes in End-Stage Renal Disease Study Team consists of members from the Johns Hopkins University, Baltimore, Maryland (L. Ebony Boulware, Karen Bandeen-Roche, Courtney Cook, Josef Coresh, Deidra Crews, Patti Ephraim, Bernard Jaar, Jeonyong Kim, Yang Liu, Jason Luly, Aidan McDermott, Paul Scheel, Tariq Shafi, Stephen M. Sozio, Albert Wu, Jing Zhou); University of California, San Francisco, California (Neil Powe); Chronic Disease Research Group, Minneapolis, Minnesota (Allan Collins, Robert Foley, David Gilbertson, Haifeng Guo, Charles Herzog, Jiannong Liu, Wendy St. Peter); Cleveland Clinic Foundation, Cleveland, Ohio (Joseph Nally, Susana Arrigain, Stacey Jolly, Vicky Konig, Xiaobo Liu, Sankar Navaneethan, Jesse Schold,); University of New Mexico (Philip Zager); Tufts University, Boston, Massachusetts (Dana Miskulin, Klemens Meyer); University of Miami, Miami, Florida (Julia Scialla); University of Manitoba, Winnipeg, Manitoba (Navdeep Tangri); and Academic Medical Center, Amsterdam, The Netherlands (Wieneke Michels). Parts of this work were presented at the 2012 Annual Meeting of the American Society of Nephrology in San Diego, California, November 1 through 4, 2012. The authors thank Chronic Disease Research Group colleagues Pamela Giles for manuscript preparation and Nan Booth, MSW, MPH, ELS, for manuscript editing. The authors express their gratitude to the staff and patients of Dialysis Clinic Inc. Funding Information: Our study was part of the broader Developing Evidence to Inform Decisions about Effectiveness (DEcIDE) Network Patient Outcomes in End-Stage Renal Disease (DEcIDE-ESRD) Study funded by the Agency for Healthcare Research and Quality to examine the comparative effectiveness of common treatment strategies in ESRD [17]. Cohorts were selected from patients treated in Dialysis Clinic, Inc., (DCI) facilities 2003–2008. DCI is a not-for-profit medium-sized dialysis provider in the US with over 210 clinics in 27 states. DCI patient characteristics are similar to those of US dialysis patients in general, with an overrepresentation of black patients [1]. We linked DCI data to United States Renal Data System (USRDS) registry data to obtain additional information.",
year = "2013",
doi = "10.1186/1471-2369-14-249",
language = "English (US)",
volume = "14",
journal = "BMC Nephrology",
issn = "1471-2369",
publisher = "BioMed Central",
number = "1",
}