Patterns in blood pressure medication use in US incident dialysis patients over the first 6 months.
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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.
Practice Patterns, Physicians'
Renal Insufficiency, Chronic
Published Version (Please cite this version)10.1186/1471-2369-14-249
Publication InfoSt Peter, Wendy L; Sozio, Stephen M; Shafi, Tariq; Ephraim, Patti L; Luly, Jason; McDermott, Aidan; ... DEcIDE Network Patient Outcomes in End-Stage Renal Disease Study Investigators (2013). Patterns in blood pressure medication use in US incident dialysis patients over the first 6 months. BMC Nephrol, 14. pp. 249. 10.1186/1471-2369-14-249. Retrieved from https://hdl.handle.net/10161/8332.
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Eleanor Easley Distinguished Professor in the School of Medicine
Dr. Boulware is the Eleanor Easley Distinguished Professor in the Duke University School of Medicine. She serves as Chief of the Division of General Internal Medicine in the Department of Medicine, Vice Dean for Translational Science, and Associate Vice Chancellor for Translational Research at Duke. She is a general internist and clinical epidemiologist. She studies mechanisms to improve the quality and equity of health care and health outcomes for individuals and populations affected by chro
Adjunct Associate Professor in the Department of Medicine
Dr. Scialla is an Associate Professor of Medicine in Nephrology at Duke University and a faculty member at the Duke Clinical Research Institute. Dr. Scialla trained in Internal Medicine, Nephrology, and Clinical Epidemiology at the Johns Hopkins University School of Medicine and the Johns Hopkins Bloomberg School of Public Health. Her research focuses on chronic kidney disease (CKD) epidemiology and prevention, with an emphasis on the role of metabolic complications and nutri
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