Dialysis Outcomes and Practice Patterns Study (DOPPS) data on medications in hemodialysis patients.
BACKGROUND
Medications affect many measures of hemodialysis patients' well-being.


METHODS
The Dialysis Outcomes and Practice Patterns Study (DOPPS) has evaluated the use of hydroxymethyl glutaryl coenzyme A reductase inhibitors (statins), analgesics, antidepressants, and multivitamins. Additionally, DOPPS has reported on the associations between vascular access outcomes and related medications.


RESULTS
Prescription of statins varied widely across countries, with the highest use in the United States. Patients prescribed statins had lower risk of cardiac and noncardiac causes of mortality than those who were not prescribed statins. DOPPS data also show that statins are underprescribed relative to recent Kidney Disease Outcomes Quality Initiative guidelines. No guidelines have been established for analgesic use, but high pain levels self-reported by hemodialysis patients suggest opportunities for improved pain management strategies. Guidelines for analgesic use in dialysis patients may help balance improved quality of life against potential side effects of analgesics. Medical and patient questionnaires show that depression in hemodialysis patients is common, frequently underdiagnosed, usually untreated, and associated with increased rates of mortality and hospitalization. Calcium channel blockers were associated with improved primary graft patency, aspirin with improved secondary graft patency, and angiotensin-converting enzyme inhibitors with improved secondary fistula patency. All 3 medications were associated with significantly decreased relative risk for access failure. There is large country variation in multivitamin use, with significantly higher use in the United States compared with Europe and Japan. Patients taking multivitamins had lower mortality risk than patients not taking multivitamins.


CONCLUSIONS
DOPPS findings on medications indicate that prospective trials are needed before guidelines can be developed for appropriate medication use in these different therapeutic categories.
Andreucci
Vittorio E
VE
Universita Federico II, Naples, Italy.
Fissell
Rachel B
RB
Bragg-Gresham
Jennifer L
JL
Ethier
Jean
J
Greenwood
Roger
R
Pauly
Mark
M
Wizemann
Volker
V
Port
Friedrich K
FK
D000700:Analgesics; D000928:Antidepressive Agents; D001166:Arteriovenous Shunt, Surgical; D002408:Catheters, Indwelling; D004358:Drug Therapy; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D007676:Kidney Failure, Chronic / Q000628:therapy; D009017:Morbidity; D017063:Outcome Assessment, Health Care; D006435:Renal Dialysis / Q000592:standards; D014815:Vitamins
D000700:Analgesics; D000928:Antidepressive Agents; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D014815:Vitamins