Adherence to drug therapy in kidney disease

E.J.C. Magacho,M.G. Bastos,A. Chaoubah,L.C. Ribeiro

doi:10.1590/s0100-879x2011007500013

Abstract

Non-adherence to drug therapy has not been extensively studied in patients with chronic kidney disease (CKD). The objective of the present study was to identify determinants of non-adherence to drug therapy in patients with CKD, not on dialysis. A prospective cohort study involving 149 patients was conducted over a period of 12 months. Adherence to drug therapy was evaluated by the self-report method at baseline and at 12 months. Patients who knew the type of drug(s) and the respective number of prescribed pills in use at the visit preceding the interview were considered to be adherent. Patients with cognitive decline were assessed by interviewing their caregivers. Mean patient age was 51 ± 16.7 years. Male patients predominated (60.4%). Univariate analysis performed at baseline showed that non-adherence was associated with older age, more pills taken per day, worse renal function, presence of coronary artery disease, and reliance on caregivers for the administration of their medications. In multivariate analysis, the factors that were significantly associated with non-adherence were daily use of more than 5 pills and drug administration by a caregiver. Longitudinal evaluation showed an increase in non-adherence over time. Medication non-adherence was lower (17.4%) at the baseline period of the study than after 1 year of the study (26.8%). Compared to the baseline period, the percentage of adherent patients who became non-adherent (22%) was lower than the percentage of non-adherent patients who became adherent (50%). In CKD patients not on dialysis, non-adherence was significantly associated with the number of pills taken per day and drug administration by third parties. Adherence is more frequent than non-adherence over time.

Highlights

Chronic kidney disease (CKD) is a major public health problem and its diagnosis is greatly facilitated by the criteria of the Kidney Disease Outcomes Quality Initiative (K/DOQI) of the US National Kidney Foundation [1]
The study was conducted over two periods: at the baseline period the data were obtained when the patients came to the Clinic and consisted of demographic, clinical, and laboratory data and patient’s lifestyle; adherence to drug therapy was assessed by the self-report method [16,17], which consisted of the patient’s information about which drugs he had taken since the last follow-up visit
Non-adherence to drug therapy among patients with kidney disease who were not on dialysis was found to be associated with a larger number of pills taken per day and drug administration by a caregiver

Summary

Introduction

Chronic kidney disease (CKD) is a major public health problem and its diagnosis is greatly facilitated by the criteria of the Kidney Disease Outcomes Quality Initiative (K/DOQI) of the US National Kidney Foundation [1]. Slowing the rate of disease progression in the early stages of CKD is a major goal, together with monitoring and correcting its complications and comorbidities, and treating the underlying disease. To achieve these goals, adherence to treatment plays a major role, whereas non-adherence to prescribed drugs significantly increases morbidity and mortality in developing countries [3,4]. According to the World Health Organization (WHO), “adherence is a person’s behavior concerning taking medication, following a diet, and making changes in lifestyle in accordance with a medical or non-medical health professional recommendations” [5]

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Conclusion