{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T22:07:04Z","timestamp":1783721224262,"version":"3.55.0"},"reference-count":29,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2023,2,23]],"date-time":"2023-02-23T00:00:00Z","timestamp":1677110400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pharmacy"],"abstract":"<jats:p>We investigated the relationship between multidrug administration and the characteristics, pathophysiology, and drug class in outpatients with hemodialysis. A retrospective cross-sectional study was conducted at Saitama Medical University Hospital in October 2018. Multidrug administration was defined as receiving either more than six drugs or more than the median number of drugs. The drugs used were represented by their anatomical classification codes in the Anatomical Therapeutic Chemistry Classification System (ATC classification). A latent class analysis (LCA) was used to identify clusters at risk of receiving multiple medications. A stepwise logistic regression analysis was performed to select ATC classifications prone to being involved in multidrug administration. As of October 2018, 98 outpatients with hemodialysis were enrolled in the study. In the LCA, when diabetes was the main primary disease, oral hypoglycemic agents available to dialysis patients were limited, but the number of drugs administered was large. Old age, poor nourishment, a long history of dialysis, and chronic nephritis were associated with multidrug administration among nondiabetic patients. In the second level of the ATC classification, the drugs frequently used were coded A02 (drugs for acid-related disorders), A07 (antidiarrheal agents, intestinal anti-inflammatory\/anti-infective agents), B01 (antithrombotic agents), and N05 (psycholeptics). The prescribing patterns for either diabetic patients or nondiabetic elderly patients were identified in outpatients with hemodialysis taking multiple medications, and drugs for acid-related disorders, antidiarrheal agents, intestinal anti-inflammatory\/anti-infective agents, antithrombotic agents, and psycholeptics are frequently used in those patients.<\/jats:p>","DOI":"10.3390\/pharmacy11020043","type":"journal-article","created":{"date-parts":[[2023,2,23]],"date-time":"2023-02-23T02:57:34Z","timestamp":1677121054000},"page":"43","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Identification of Prescribing Patterns in Hemodialysis Outpatients Taking Multiple Medications"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0318-1604","authenticated-orcid":false,"given":"Hiroyuki","family":"Nagano","sequence":"first","affiliation":[{"name":"Department of Pharmacy, Saitama Medical University Hospital, 38 Morohongo, Moroyama-machi, Iruma-gun, Saitama 350-0495, Japan"},{"name":"Department of Pharmacotherapy, Meiji Pharmaceutical University, 2-522-1 Noshio, Kiyose-shi, Tokyo 204-8588, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Koji","family":"Tomori","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Faculty of Medicine, Saitama Medical University, 38 Morohongo, Moroyama-machi, Iruma-gun, Saitama 350-0495, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8554-9187","authenticated-orcid":false,"given":"Mano","family":"Koiwa","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Saitama Medical University Hospital, 38 Morohongo, Moroyama-machi, Iruma-gun, Saitama 350-0495, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shotaro","family":"Kobayashi","sequence":"additional","affiliation":[{"name":"Department of Pharmacotherapy, Meiji Pharmaceutical University, 2-522-1 Noshio, Kiyose-shi, Tokyo 204-8588, Japan"},{"name":"Department of Pharmacy, Sonoda Daiichi Hospital, 4-1-12 Takenotsuka, Adachi-ku, Tokyo 121-0813, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masahiro","family":"Takahashi","sequence":"additional","affiliation":[{"name":"Department of Pharmacotherapy, Meiji Pharmaceutical University, 2-522-1 Noshio, Kiyose-shi, Tokyo 204-8588, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hideki","family":"Makabe","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Saitama Medical University Hospital, 38 Morohongo, Moroyama-machi, Iruma-gun, Saitama 350-0495, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hirokazu","family":"Okada","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Faculty of Medicine, Saitama Medical University, 38 Morohongo, Moroyama-machi, Iruma-gun, Saitama 350-0495, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1385-7487","authenticated-orcid":false,"given":"Akifumi","family":"Kushiyama","sequence":"additional","affiliation":[{"name":"Department of Pharmacotherapy, Meiji Pharmaceutical University, 2-522-1 Noshio, Kiyose-shi, Tokyo 204-8588, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,2,23]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1111\/j.1041-2972.2005.0020.x","article-title":"Polypharmacy in the elderly: A literature review","volume":"17","author":"Fulton","year":"2005","journal-title":"J. Am. Acad. Nurse Pract."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"521","DOI":"10.1038\/clpt.2011.258","article-title":"High-risk prescribing and incidence of Frailty among older community-dwelling men","volume":"91","author":"Gnjidic","year":"2012","journal-title":"Clin. Pharmacol. Ther."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"425","DOI":"10.1111\/j.1447-0594.2011.00783.x","article-title":"Polypharmacy as a risk for fall occurrence in geriatric outpatients","volume":"12","author":"Kojima","year":"2011","journal-title":"Geriatr. Gerontol. Int."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"761","DOI":"10.1111\/j.1447-0594.2012.00868.x","article-title":"High risk of adverse drug reactions in elderly patients taking six or more drugs: Analysis of inpatient database","volume":"12","author":"Kojima","year":"2012","journal-title":"Geriatr. Gerontol. Int."},{"key":"ref_5","unstructured":"(2021, September 10). Guidelines for Medical Treatment and Its Safety in the Elderly. The Japan Geriatrics Society. Available online: https:\/\/www.jpn-geriat-soc.or.jp\/info\/topics\/pdf\/20170808_01.pdf."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"663","DOI":"10.1093\/ckj\/sfz046","article-title":"Patterns of medication use and the burden of polypharmacy in patients with chronic kidney disease: The German Chronic Kidney Disease study","volume":"12","author":"Schmidt","year":"2019","journal-title":"Clin. Kidney J."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Santos-D\u00edaz, G., P\u00e9rez-Pico, A., Su\u00e1rez-Santisteban, M., Garc\u00eda-Bernalt, V., Mayordomo, R., and Dorado, P. (2020). Prevalence of Potential Drug\u2013Drug Interaction Risk among Chronic Kidney Disease Patients in a Spanish Hospital. Pharmaceutics, 12.","DOI":"10.3390\/pharmaceutics12080713"},{"key":"ref_8","unstructured":"(2020, October 06). JSDT Renal Data Registry 2019. Japanese: The Japanese Society for Dialysis Therapy. Available online: https:\/\/docs.jsdt.or.jp\/overview\/index.html."},{"key":"ref_9","unstructured":"(2019, September 10). Chapter 11: International Comparison, the 2018 USRDS Annual Data Report. Washington: United States Renal Data System. Available online: https:\/\/www.usrds.org\/2018\/view\/v2_11.aspx."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"156","DOI":"10.1007\/s10157-007-0463-x","article-title":"Prevalence of chronic kidney disease (CKD) in the Japanese general population predicted by the MDRD equation modified by a Japanese coefficient","volume":"11","author":"Imai","year":"2007","journal-title":"Clin. Exp. Nephrol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1089","DOI":"10.2215\/CJN.00290109","article-title":"Pill Burden, Adherence, Hyperphosphatemia, and Quality of Life in Maintenance Dialysis Patients","volume":"4","author":"Chiu","year":"2009","journal-title":"Clin. J. Am. Soc. Nephrol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"571","DOI":"10.4009\/jsdt.49.571","article-title":"The magnesium included as a pharmaceutical excipient in phosphate binders might affect the serum magnesium levels of dialysis patients","volume":"49","author":"Nagano","year":"2016","journal-title":"Nihon Toseki Igakkai Zasshi"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"245","DOI":"10.2147\/CLEP.S226586","article-title":"Patterns of Multimorbidity and Differences in Healthcare Utilization and Complexity among Acutely Hospitalized Medical Patients (\u226565 Years)\u2014A Latent Class Approach","volume":"12","author":"Christensen","year":"2020","journal-title":"Clin. Epidemiol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"671","DOI":"10.1080\/10705510701575602","article-title":"PROC LCA: A SAS Procedure for Latent Class Analysis","volume":"14","author":"Lanza","year":"2007","journal-title":"Struct. Equ. Model. Multidiscip. J."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"637","DOI":"10.1002\/pds.3772","article-title":"Polypharmacy and frailty: Prevalence, relationship, and impact on mortality in a French sample of 2350 old people","volume":"24","author":"Herr","year":"2015","journal-title":"Pharmacoepidemiol. Drug Saf."},{"key":"ref_16","unstructured":"(2021, October 02). Dosage Recommendations for Drugs That Require the Most Attention in Renal Impairment. The Japanese Society of Nephrology and Pharmacotherapy. Available online: https:\/\/www.jsnp.org\/docs\/%E8%85%8E%E6%A9%9F%E8%83%BD%E4%BD%8E%E4%B8%8B%E6%99%82%E3%81%AB%E6%9C%80%E3%82%82%E6%B3%A8%E6%84%8F%E3%81%AE%E5%BF%85%E8%A6%81%E3%81%AA%E8%96%AC%E5%89%A4%E6%8A%95%E4%B8%8E%E9%87%8F%E4%B8%80%E8%A6%A7_34.1%E7%89%88.pdf."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1455","DOI":"10.1046\/j.1523-1755.2003.00225.x","article-title":"Risk factors for upper gastrointes-tinal bleeding among end-stage renal disease patients","volume":"64","author":"Wasse","year":"2003","journal-title":"Kidney Int."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1027","DOI":"10.1016\/j.jcma.2018.03.007","article-title":"Risk factors of the peptic ulcer bleeding in aging uremia patients under regular hemodialysis","volume":"81","author":"Lin","year":"2018","journal-title":"J. Chin. Med. Assoc."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"15","DOI":"10.4103\/abr.abr_37_18","article-title":"The Interaction of Helicobacter pylori Infection and Type 2 Diabetes Mellitus","volume":"8","author":"Nabavi","year":"2019","journal-title":"Adv. Biomed. Res."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1887","DOI":"10.4009\/jsdt.37.1887","article-title":"A survey of constipation in dialysis patients","volume":"37","author":"Nishihara","year":"2004","journal-title":"Nihon Toseki Igakkai Zasshi"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1463","DOI":"10.1007\/s11255-017-1598-7","article-title":"Close correlation between the ankle-brachial index and symptoms of depression in hemodialysis patients","volume":"49","author":"Jong","year":"2017","journal-title":"Int. Urol. Nephrol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1141","DOI":"10.1681\/ASN.2004090765","article-title":"High Prevalence of Occult Coronary Artery Stenosis in Patients with Chronic Kidney Disease at the Initiation of Renal Replacement Therapy: An Angiographic Examination","volume":"16","author":"Ohtake","year":"2005","journal-title":"J. Am. Soc. Nephrol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"472","DOI":"10.1053\/ajkd.2002.34885","article-title":"The prevalence of peripheral arterial disease and medial arterial calcification in patients with chronic renal failure: Requirements for diagnostics","volume":"40","author":"Leskinen","year":"2002","journal-title":"Am. J. Kidney Dis."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"192","DOI":"10.14336\/AD.2017.0429","article-title":"The Prevalence of Frailty and its Associated Factors in Japanese Hemodialysis Patients","volume":"9","author":"Takeuchi","year":"2018","journal-title":"Aging Dis."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"228","DOI":"10.1053\/j.ajkd.2016.08.034","article-title":"Frailty, Kidney Function, and Polypharmacy: The Atherosclerosis Risk in Communities (ARIC) Study","volume":"69","author":"Ballew","year":"2017","journal-title":"Am. J. Kidney Dis."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"594","DOI":"10.3904\/kjim.2014.331","article-title":"The Korean version of the FRAIL scale: Clinical fea-sibility and validity of assessing the frailty status of Korean elderly","volume":"31","author":"Jung","year":"2016","journal-title":"Korean J. Intern. Med."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"923","DOI":"10.1007\/s11357-013-9590-3","article-title":"Multi-morbidity, dependency, and frailty singly or in combination have different impact on health outcomes","volume":"36","author":"Woo","year":"2013","journal-title":"Age"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1111\/jgs.13877","article-title":"Effects of Changes in Number of Medications and Drug Burden Index Exposure on Transitions Between Frailty States and Death: The Concord Health and Ageing in Men Project Cohort Study","volume":"64","author":"Jamsen","year":"2016","journal-title":"J. Am. Geriatr. Soc."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"e27","DOI":"10.1111\/jgs.14718","article-title":"Is Polypharmacy Associated with Frailty in Older People? Results From the ESTHER Cohort Study","volume":"65","author":"Saum","year":"2016","journal-title":"J. Am. Geriatr. Soc."}],"container-title":["Pharmacy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2226-4787\/11\/2\/43\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T18:40:05Z","timestamp":1760121605000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2226-4787\/11\/2\/43"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,2,23]]},"references-count":29,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2023,4]]}},"alternative-id":["pharmacy11020043"],"URL":"https:\/\/doi.org\/10.3390\/pharmacy11020043","relation":{},"ISSN":["2226-4787"],"issn-type":[{"value":"2226-4787","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,2,23]]}}}