Polypharmacy and Accompanying Comorbid Conditions in Kidney Transplant Recipients: A Retrospective Study

Öz

Background: Kidney transplantation improves survival and quality of life, yet post-transplant care frequently necessitates complex pharmacotherapy due to immunosuppressive regimens and management of comorbidities. This often results in polypharmacy, which is associated with increased risk of adverse outcomes. In this study, we aimed to evaluate the immunosuppressive and other medications used in kidney transplant recipients, as well as the accompanying comorbid conditions. Methods: In this cross-sectional, multicenter study, 342 kidney transplant recipients were stratified into two groups: low-risk (≤5 medications) and moderate-to-high risk (≥6 medications) polypharmacy. Demographic, clinical, and laboratory data were analyzed to identify predictors of polypharmacy using multivariate logistic regression. Results: Moderate-to-high polypharmacy was observed in 64.9% of patients. This group had significantly higher creatinine, blood urea nitrogen (BUN), and glucose levels, and lower eGFR and hemoglobin values (all p < 0.05). Hypertension, diabetes, and coronary artery disease were more common in this group (p = 0.001). In multivariate analysis, hypertension (OR: 4.615), proton pump inhibitor use (OR: 5.705), and allopurinol use (OR: 10.894) were independently associated with polypharmacy, while anticoagulant use was inversely associated (OR: 0.237; all p < 0.01). Conclusion: Polypharmacy is prevalent among our kidney transplant recipients and is associated with impaired graft function, anemia, and higher comorbidity burden. Certain medications, particularly PPIs and allopurinol, are strong predictors of polypharmacy. These findings highlight the need for individualized medication review, deprescribing strategies, and integration of pharmacogenomics into routine care to optimize outcomes in transplant recipients.

Anahtar Kelimeler

• Polypharmacy
• Kidney transplantation
• Comorbidities
• Medication manage-ment
• Immunosuppressive therapy

Böbrek Nakli Alıcılarında Polifarmasi ve Eşlik Eden Komorbid Durumlar: Retrospektif Bir Çalışma

Öz

Giriş: Böbrek nakli, hastaların yaşam süresini ve kalitesini artırır; ancak nakil sonrası bakım, immünsüpresif tedavi ve komorbid hastalıkların yönetimi nedeniyle çoğu zaman karmaşık bir ilaç tedavisini zorunlu kılar. İmmünsüpresif tedavilerin ve eşlik eden hastalıkların yönetimi, genellikle polifarmasiye neden olur; bu da advers olayların gelişme riskini önemli ölçüde artırır. Bu çalışmada, böbrek nakli alıcılarında kullanılan immünsüpresif ve diğer ilaçları ile eşlik eden komorbid durumları değerlendirmeyi amaçladık. Yöntemler: Bu çok merkezli, kesitsel çalışmada, 342 böbrek nakli alıcısı düşük riskli (≤5 ilaç) ve orta-yüksek riskli (≥6 ilaç) polifarmasi gruplarına ayrıldı. Polifarmasiyi öngören faktörleri belirlemek için demografik, klinik ve laboratuvar verileri çok değişkenli lojistik regresyon analizi ile değerlendirildi. Bulgular: Hastaların %64,9’unda orta-yüksek düzeyde polifarmasi gözlendi. Bu grupta kreatinin, kan üre azotu ve glukoz düzeyleri anlamlı derecede daha yüksek; tahmini GFR ve hemoglobin düzeyleri ise daha düşüktü (tüm p < 0,05). Hipertansiyon, diyabet ve koroner arter hastalığı bu grupta daha yaygındı (p = 0,001). Çok değişkenli analizde hipertansiyon (OR: 4,615), proton pompa inhibitörü kullanımı (OR: 5,705) ve allopurinol kullanımı (OR: 10,894) polifarmasi ile bağımsız olarak ilişkiliydi; antikoagülan kullanımı ise ters yönde ilişkiliydi (OR: 0,237; tüm p < 0,01). Sonuç: Böbrek nakli alıcılarımızda polifarmasi yaygındır ve bozulmuş greft fonksiyonu, anemi ve yüksek komorbidite yükü ile ilişkilidir. Özellikle PPI ve allopurinol gibi bazı ilaçlar polifarmasinin güçlü belirleyicileridir. Bu bulgular, transplant alıcılarında bireyselleştirilmiş ilaç değerlendirmesi, ilaç bırakma stratejileri ve farmakogenomiğin rutin bakıma entegrasyonunun önemini vurgulamaktadır.

Anahtar Kelimeler

• Polifarmasi
• Böbrek nakli
• Komorbiditeler
• İlaç yönetimi
• İmmünsüpresif tedavi

Kaynakça

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