529-P: Impact of Medication Adherence (MA) to Oral Glycemic Agents (OHAs) on Initiation of Dialysis in Patients with Moderately Impaired Renal Function

Abstract

Although we showed a significant association of poor adherence to OHAs with start of dialysis, this relationship according to the estimated glomerular filtration rate (eGFR) was not clarified. Patients with eGFR <60 mL/min/1.73m2 are at high risk for dialysis. To identify the impact of MA by eGFR categories, we analyzed a nationwide claims-based database of 7,862 people with DM and without prior dialysis from 2008-16 aged 18-72 y with available records for OHAs for at least 1 year (mean age 54 y, HbA1c 7.2%) . MA was evaluated by the proportion of days covered (PDC) , and PDC <80% indicated poor adherence. Other factors were also analyzed (Table) . Median follow-up was 5.1 years. Incidence of dialysis per 1000 person-years was 10.7 in the eGFR<60 group and 0.62 in the eGFR ≥60 group. By Cox regression analysis (Table) an increased risk of dialysis was associated with poor MA (HR 2.98[95% CI 1.69-5.23]) , high systolic blood pressure (SBP) (1.27[1.11-1.44]) ], or current smoking (1.98[1.11-3.51]) in the eGFR<60 group and with high SBP (1.41[1.10-1.80]) and high HbA1c (1.45[1.13-1.87]) in the eGFR ≥60 group. Other factors in addition to MA might lead to dialysis, but poor MA was a strong risk factor for dialysis in this short observation period, especially in patients with impaired renal function. Clinicians should pay special attention to MA in these patients to prevent dialysis. Disclosure Y.Yaguchi: None. H.Sone: Research Support; Astellas Pharma Inc., Eisai Co., Ltd., Kyowa Kirin Co., Ltd., Novo Nordisk, Ono Pharmaceutical Co., Ltd., Taisho Pharmaceutical Holdings Co., Ltd., Takeda Pharmaceutical Company Limited. K.Fujihara: None. M.H.Yamada: None. Y.Matsubayashi: None. T.Yamada: None. M.Iwanaga: None. M.Kitazawa: None. M.Yamamoto: None. S.Kodama: None.