Retrospective assessment of medication patterns among candidates evaluated for living kidney donation

Introduction

Medication use in living kidney donor (LKD) candidates may have important implications for evaluation and donation care. We sought to characterize LKD candidate medication use through medication histories conducted at nephrologist evaluation and transplant pharmacist preoperative visits.

Methods

This retrospective single-center cohort study included adult LKD candidates evaluated for donation between October 1, 2019 and October 1, 2021. Scheduled and as-needed medications for each candidate were abstracted from pre-donation medication histories collected at the evaluation visit with the nephrologist and the preoperative visit with the transplant pharmacist, if approved for donation. Medication histories from each visit were compared with each other and evaluated by therapeutic class frequency.

Results

Among 213 LKD candidates (112 approved for donation and 101 declined for donation), 198 (93.0%) candidates were taking at least one prescription medication, over-the-counter agent, or dietary supplement. Antidepressants and antihypertensives were the most common prescription agents used among candidates, with antihypertensives more common among declined donors (20.8% vs. 10.7%, p = 0.042). Nonsteroidal anti-inflammatory drugs were more commonly identified at the evaluation visit of approved candidates compared to the preoperative visit (29.5% vs. 0.9%, p < 0.001) and dietary supplements were more commonly identified at the preoperative visit compared to the evaluation visit (49.1% vs. 59.8%, p = 0.023).

Conclusions

The frequency of nonsteroidal anti-inflammatory drugs decreased greatly between the evaluation and preoperative visit, likely reflective of discontinuation pre-donation. Characterizing medication use among candidates evaluated for LKD donation may assist donor programs with developing more targeted patient medication education. Nearly all LKD candidates were taking a medication or dietary supplement pre-donation. Transplant pharmacists are uniquely positioned to perform medication reconciliations and can also offer guidance to other team providers on best practices for this process. A better understanding of medication patterns in this population may also aid with further developing care guidelines for LKD evaluation and pre-/postoperative LKD care.