Assessing Individual Medication Adherence among Chronic Kidney Disease Patients: A Multi-centered Study

Abstract

Aims: This study aims to identify differences in outcomes of assessing overall versus individual adherence and factors associated with adherence to medication therapy in chronic kidney disease patients.
 Study Design: This is a cross-sectional study.
 Place and Duration of Study: Nephrology Clinic, Universiti Kebangsaan Malaysia Medical Centre and Ministry of Health Hospitals between June 2018 and June 2019.
 Methodology: We included 491 patients (243 men, 248 women); average age of 54.5 (±14.6) years with chronic kidney disease and prescribed at least one medication, using a validated questionnaire.
 Results: Patients were prescribed an average of 7.0±2.4 medications. Majority were categorized as adherent (n=404, 82.3%) based on an overall assessment. In contrast, only 27.5% (n=135) were adherent when medications were assessed individually. Based on individual medication assessment, a multivariate logistic regression demonstrated patients aged >55 years were 2.3 times more likely to be adherent toward medicines (P=.001). Those with <3 comorbidities and <7 medications increased the odds of adherence by 2.1 (P=.002) and 2.2 (P=.001) times respectively. Having a drug knowledge score >80% increase the odds of adherence by 8.7 times compared to their counterparts (P<.01).
 Conclusion: Potential strategies for targeted management should be developed in order to remove barriers towards medication adherence in chronic kidney disease patients.

Factors associated with the frequency of antihypertensive drug adjustments in chronic kidney disease patients: a multicentre, 2-year retrospective study

“…Poor adherence increases the risk of adverse events or medication efficacy loss, which then require frequent adjustments to, or intensification of medication regimen [ 8 , 11 ]. Poor adherence is multifactorial [ 2 , 4 , 31 , 32 ], with high medication burden and complex administration regimen often associated with poor adherence [ 32 ]. In addition, poor adherence is associated with poorer blood pressure control [ 4 ] and increased risk of CKD progression [ 4 , 31 ], which ultimately lead to changes in medications.…”

“…Interestingly, this work demonstrates the need for pharmacists to strengthen CKD patient care, among those with antihypertensive drug adjustments, via monitoring their medication adherence, TCM use, albuminuria status, as well as education on correct medication knowledge, belief and management skills [ 31 , 33 ]. Knowledge of CKD and treatment delays CKD progression and minimises CKD complications [ 2 ]. The potential benefits of pharmacist involvement are beyond the improvement of medication adherence, ranging from reduced hospitalisation rates to increased savings to healthcare systems [ 34 ].…”

“…Chronic kidney disease (CKD) is a global concern with an estimated worldwide prevalence of 9.1% [ 1 ]. Currently, there are no medications to treat the disease itself [ 2 ]. As such, CKD patients require multiple drugs to manage the various co-morbidities, to slow disease progression, and to mitigate complications [ 2 , 3 ].…”

“…Currently, there are no medications to treat the disease itself [ 2 ]. As such, CKD patients require multiple drugs to manage the various co-morbidities, to slow disease progression, and to mitigate complications [ 2 , 3 ]. This gives rise to a substantially high medication burden, especially among advanced CKD patients, with some requiring more than 10 types of medication daily [ 2 – 5 ].…”

Patient-related factors associated with medication adherence behavior in patients with end-stage renal disease

“…In one study, Kim and Evangelista[ 41 ] found that treatment control had a significant correlation with non-adherence, i.e., patients with a higher level of perception of uncontrollability of their illness displayed a higher nonadherence. In addition, three studies investigated patients' medication knowledge and these studies found that patients were more likely to be nonadherent when they have less medical knowledge about the medication, they have been prescribed[ 37 38 41 ].…”