{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T19:00:16Z","timestamp":1775070016625,"version":"3.50.1"},"reference-count":29,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,6,19]],"date-time":"2021-06-19T00:00:00Z","timestamp":1624060800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,6,19]],"date-time":"2021-06-19T00:00:00Z","timestamp":1624060800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Nephrol"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background and objectives<\/jats:title>\n                <jats:p>After dialysis initiation, older adults may experience orthostatic or post-dialysis hypotension. Some orthostasis-causing antihypertensives (i.e., central alpha agonists and alpha blockers), are considered potentially inappropriate medications (PIMs) for older adults because they carry more risk than benefit. We sought to (1) describe antihypertensive PIM prescribing patterns before and after dialysis initiation and (2) ascertain the potential risk of adverse outcomes when these medications are continued after dialysis initiation.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Design, setting, participants, and measurements<\/jats:title>\n                <jats:p>Using United States Renal Data System data, we evaluated monthly prevalence of antihypertensive PIM claims in the period before and after dialysis initiation among older adults aged \u226566\u2009years initiating in-center hemodialysis in the US between 2013 and 2014. Patients with an antihypertensive PIM prescription at hemodialysis initiation and who survived for 120\u2009days were classified as \u2018continuers\u2019 or \u2018discontinuers\u2019 based on presence or absence of a refill within the 120\u2009days after initiation. We compared rates of hospitalization and risk of death across these groups from day 121 through 24\u2009months after dialysis initiation.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Our study included 30,760 total patients, of whom 5981 (19%) patients had an antihypertensive PIM claim at dialysis initiation and survived \u2265120\u2009days. Most [65% (<jats:italic>n<\/jats:italic>\u00a0=\u20093920)] were continuers. Those who continued (versus discontinued) were more likely to be black race\u00a0(26% versus 21%), have dual Medicare-Medicaid coverage (31% versus 27%), have more medications on average (12 versus 9) and have no functional limitations (84% versus 80%). Continuers experienced fewer all-cause hospitalizations and deaths, but neither were statistically significant after adjustment (Hospitalization: RR 0.93, 95% CI 0.86, 1.00; Death: HR 0.89, 95% CI: 0.78\u20131.02).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>Nearly one in five older adults had an antihypertensive PIM at dialysis initiation. Among those who survived \u2265120\u2009days, continuation of an antihypertensive PIM was not associated with increased risk of all-cause hospitalization or mortality.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12882-021-02438-3","type":"journal-article","created":{"date-parts":[[2021,6,19]],"date-time":"2021-06-19T19:02:32Z","timestamp":1624129352000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Risks associated with continuation of potentially inappropriate antihypertensive medications in older adults receiving hemodialysis"],"prefix":"10.1186","volume":"22","author":[{"given":"Rasheeda K.","family":"Hall","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sarah","family":"Morton","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jonathan","family":"Wilson","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Patti L.","family":"Ephraim","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"L. 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Given the retrospective nature of this study and the deidentified data, informed consent was waived for this study by the Duke University Institutional Review Board (Pro00100199). All methods were performed in accordance with relevant regulations and guidelines.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not Applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"RH has received consulting fees from United Health Group. JJS has received consulting fees from Tricida and modest research support for clinical event activities related to trials sponsored by Eli Lilly, Sanofi and GlaxoSmithKline. No other disclosures to report for other authors.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"232"}}