Association of Potentially Inappropriate Medication Classes with Mortality Risk Among Older Adults Initiating Hemodialysis

Background and Objective: Older adults initiating dialysis have a high risk of mortality and that risk may be related to potentially inappropriate medications (PIMs). Our objective was to identify and validate mortality risk associated with American Geriatrics Society Beers Criteria PIM classes and concomitant PIM use. Methods: We used US Renal Data System data to establish a cohort of adults aged ≥ 65 years initiating dialysis (2013–2014) and had no PIM prescriptions in the 6 months prior to dialysis initiation. In a development cohort (40% sample), adjusted Cox proportional hazards models were performed to determine which of 30 PIM classes were associated with mortality (or “high-risk” PIMs). Adjusted Cox models were performed to assess the association of the number of “high-risk” PIM fills/month with mortality. All models were repeated in the validation cohort (60% sample). Results: In the development cohort (n = 15,570), only 13 of 30 PIM classes were associated with a higher mortality risk. Compared with those with no “high-risk” PIM fills/month, patients having one “high-risk” PIM fill/month had a 1.29-fold (95% confidence interval 1.21–1.38) increased risk of death; those with two or more “high-risk” PIM fills/month had a 1.40-fold (95% confidence interval 1.24–1.58) increased risk. These findings were similar in the validation cohort (n = 23,569). Conclusions: Only a minority of Beers Criteria PIM classes may be associated with mortality in the older dialysis population; however, mortality risk increases with concomitant use of “high-risk” PIMs. Additional studies are needed to confirm these associations and their underlying mechanisms.