Abstract
This study examines the associations between medication adherence and burden, and health-related quality of life (HRQOL) in predialysis chronic kidney disease (CKD). A prospective study targeting adults with advanced CKD (estimated glomerular filtration rate (eGFR) < 30 mL/min/1.73 m2) and not receiving renal replacement therapy was conducted in Tasmania, Australia. The actual medication burden was assessed using the 65-item Medication Regimen Complexity Index, whereas perceived burden was self-reported using a brief validated questionnaire. Medication adherence was assessed using a four-item Morisky-Green-Levine Scale (MGLS) and the Tool for Adherence Behaviour Screening (TABS). The Kidney Disease and Quality of Life Short-Form was used to assess HRQOL. Of 464 eligible adults, 101 participated in the baseline interview and 63 completed a follow-up interview at around 14 months. Participants were predominantly men (67%), with a mean age of 72 (SD 11) years and eGFR of 21 (SD 6) mL/min/1.73 m2. Overall, 43% and 60% of participants reported medication nonadherence based on MGLS and TABS, respectively. Higher perceived medication burden and desire for decision-making were associated with nonadherent behaviour. Poorer HRQOL was associated with higher regimen complexity, whereas nonadherence was associated with a decline in physical HRQOL over time. Medication nonadherence, driven by perceived medication burden, was prevalent in this cohort, and was associated with a decline in physical HRQOL over time.
Highlights
Medication adherence is the primary determinant of treatment success, yet 43% to 78% of people receiving medications for chronic diseases are nonadherent to medical treatment. [1] The reported prevalence of medication nonadherence in chronic kidney disease (CKD) varies considerably; 12%–53% in stage 3 to 4 CKD and 21%–74% in end-stage kidney disease (ESKD) [2,3,4]
Given the strong association between perceived medication burden and medication nonadherence, we further explored factors associated with Perceived burden of medication (PBM) (Table 3a)
To examine whether factors associated with perceived medication burden were different from those affecting actual medication burden, we investigated the correlates of medication regimen complexity index (MRCI) (Table 3b)
Summary
Medication adherence is the primary determinant of treatment success, yet 43% to 78% of people receiving medications for chronic diseases are nonadherent to medical treatment. [1] The reported prevalence of medication nonadherence in chronic kidney disease (CKD) varies considerably; 12%–53% in stage 3 to 4 CKD and 21%–74% in end-stage kidney disease (ESKD) [2,3,4]. Medication adherence is the primary determinant of treatment success, yet 43% to 78% of people receiving medications for chronic diseases are nonadherent to medical treatment. [1] The reported prevalence of medication nonadherence in chronic kidney disease (CKD) varies considerably; 12%–53% in stage 3 to 4 CKD and 21%–74% in end-stage kidney disease (ESKD) [2,3,4]. Medication adherence is relevant in people with CKD, given its potential importance in slowing disease progression and, improving health outcomes. Poor adherence to antihypertensive medications in CKD, reported in nearly one-third of patients, is associated with uncontrolled. Res. Public Health 2020, 17, 371; doi:10.3390/ijerph17010371 www.mdpi.com/journal/ijerph
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