Understanding medical care of transplant recipients through integrated registry and pharmacy claims data.
BACKGROUND
Limited data exist on medication use aside from immunosuppression among large samples of kidney transplant recipients.


METHODS
We examined a novel database wherein Organ Procurement and Transplantation Network (OPTN) registry data were linked to records from a US pharmaceutical claims clearinghouse (2005-2010 claims) to examine pharmaceutical care at the first transplant anniversary (n = 16,157). We quantified the use of the following medication types within ±60 days of the first-year OPTN report according to estimated glomerular filtration rate (eGFR): antihypertensives, lipid-lowering, bone and mineral, and anemia treatments. Adjusted associations of medication use with eGFR and other clinical factors were quantified by multivariate logistic regression.


RESULTS
Requirements for multiple antihypertensive agents rose with lower eGFR, with β-blockers comprising the most commonly used antihypertensive agent. The adjusted likelihood of vitamin D (adjusted odds ratio (aOR) 2.07, 95% CI 1.19-3.59) and especially erythrocyte-stimulating agents (aOR 19.94, 95% CI 7.01-56.00) rose in a graded manner to peak with eGFR <15 versus >90, whereas statin use was most common with eGFR 30-59 ml/min/1.73 m(2). Black race was independently associated with increased use of all classes of antihypertensives and vitamin D, but lower adjusted statin use. Rapamycin-based immunosuppression was associated with increased use of statins and erythrocyte-stimulating agents.


CONCLUSIONS
Integrated registry and pharmacy fill data provide a novel tool for pharmacoepidemiologic investigations of delivered post-transplant care. Transplant recipients with reduced renal function have increased requirements for pharmaceutical care of comorbidities. Causes of racial variation in medication fills warrant further investigation.
Center for Outcomes Research, Saint Louis University School of Medicine, St. Louis, Mo., USA.
Krista L
KL
Lentine
Elizabeth
E
Anyaegbu
Ana
A
Gleisner
Mark A
MA
Schnitzler
David
D
Axelrod
Daniel C
DC
Brennan
Vikas R
VR
Dharnidharka
Elizabeth
E
Abraham
Janet E
JE
Tuttle-Newhall
D000293:Adolescent; D000328:Adult; D015897:Comorbidity; D005006:Ethnicity; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D004364:Pharmaceutical Preparations; D012042:Registries; D012044:Regression Analysis; D051437:Renal Insufficiency / Q000188:drug therapy* / Q000208:ethnology / Q000628:therapy*; D014481:United States
D007166:Immunosuppressive Agents; D004364:Pharmaceutical Preparations