Association between medication adherence and clinical outcomes in patients with chronic kidney disease: a prospective cohort study

Tangkiatkumjai, Mayuree; Walker, Dawn‐Marie; Praditpornsilpa, Kearkiat; Boardman, Helen F.

doi:10.1007/s10157-016-1312-6

Cited by 48 publications

(35 citation statements)

References 22 publications

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“… 26 In contrast, a recent study that included 332 Stage 3 to 4 CKD patients in Thailand found that low adherence was associated with increased risk for CKD progression. 27 Our results reinforce the findings of this study in a larger diverse U.S. cohort.…”

Section: Discussionsupporting

confidence: 90%

Self-reported Medication Adherence and CKD Progression

Investigators

2018

Kidney International Reports

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IntroductionIn the general population, medication nonadherence contributes to poorer outcomes. However, little is known about medication adherence among adults with chronic kidney disease (CKD). We evaluated the association of self-reported medication adherence with CKD progression and all-cause death in patients with CKD.MethodsIn this prospective observational study of 3305 adults with mild-to-moderate CKD enrolled in the Chronic Renal Insufficiency Cohort (CRIC) Study, the baseline self-reported medication adherence was assessed by responses to 3 questions and categorized as high, medium, and low. CKD progression (50% decline in eGFR or incident end-stage renal disease) and all-cause death were measured using multivariable Cox proportional hazards.ResultsOf the patients, 68% were categorized as high adherence, 17% medium adherence, and 15% low adherence. Over a median follow-up of 6 years, there were 969 CKD progression events and 675 deaths. Compared with the high-adherence group, the low-adherence group experienced increased risk for CKD progression (hazard ratio = 1.27, 95% confidence interval = 1.05, 1.54) after adjustment for sociodemographic and clinical factors, cardiovascular medications, number of medication types, and depressive symptoms. A similar association existed between low adherence and all-cause death, but did not reach standard statistical significance (hazard ratio = 1.14 95% confidence interval = 0.88, 1.47).ConclusionBaseline self-reported low medication adherence was associated with an increased risk for CKD progression. Future work is needed to better understand the mechanisms underlying this association and to develop interventions to improve adherence.

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Section: Discussionsupporting

confidence: 90%

Self-reported Medication Adherence and CKD Progression

Investigators

2018

Kidney International Reports

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“…Medication nonadherence is common among kidney-transplanted adolescents, estimated at 43% in a systematic review (5). Adults with CKD and poor adherence are more likely to have progressive disease (6), graft loss, and death (7). Young adults are the highest risk age-group for kidney transplant loss (8,9).…”

Section: Introductionmentioning

confidence: 99%

Associations with Wellbeing and Medication Adherence in Young Adults Receiving Kidney Replacement Therapy

Hamilton

Caskey

Casula

et al. 2018

CJASN

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Background and objectives Young adults receiving kidney replacement therapy (KRT) have impaired quality of life and may exhibit low medication adherence. We tested the hypothesis that wellbeing and medication adherence are associated with psychosocial factors.Design, setting, participants, & measurements We conducted a cross-sectional online survey for young adults on KRT. Additional clinical information was obtained from the UK Renal Registry. We compared outcomes by treatment modality using age-and sex-adjusted regression models, having applied survey weights to account for response bias by sex, ethnicity, and socioeconomic status. We used multivariable linear regression to examine psychosocial associations with scores on the Warwick-Edinburgh Mental Wellbeing Scale and the eight-item Morisky Medication Adherence Scale. ResultsWe recruited 976 young adults and 64% responded to the survey; 417 (71%) with transplants and 173 (29%) on dialysis. Wellbeing was positively associated with extraversion, openness, independence, and social support, and negatively associated with neuroticism, negative body image, stigma, psychologic morbidity, and dialysis. Higher medication adherence was associated with living with parents, conscientiousness, physician access satisfaction, patient activation, age, and male sex, and lower adherence was associated with comorbidity, dialysis, education, ethnicity, and psychologic morbidity.Conclusions Wellbeing and medication adherence were both associated with psychologic morbidity in young adults. Dialysis treatment is associated with poorer wellbeing and medication adherence.

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“…2011; Levey & Coresh 2012; Tangkiatkumjai et al . 2017), and patients with advanced CKD must adhere to fluid and diet restrictions as well as renal replacement therapy to optimise their health (Levey et al . 2009).…”

Section: Introductionmentioning

confidence: 99%

Health Literacy in Kidney Disease: Associations with Quality of Life and Adherence

Stømer

Wahl

Gøransson

et al. 2020

Journal of Renal Care

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SUMMARY Background Health literacy (HL) is a multidimensional concept with significance for self‐management and health outcomes in patients with chronic kidney disease (CKD); however, research with a multidimensional perspective on HL is scarce. Objectives This study aimed to explore the relationship between multidimensional HL, quality of life (QoL) and adherence to long‐term therapy in CKD patients. Design A descriptive single‐centre cross‐sectional study. Participants Patients with CKD in stages 3–5 were recruited from the nephrology unit in a Norwegian hospital. Measurements The Health Literacy Questionnaire (HLQ) was used to assess HL, QoL was measured by the Short Form‐12 (SF‐12) and a Visual Analogue Scale (VAS‐QoL). Adherence to long‐term therapy was measured by the Medical Adherence Rating Scale 5 (MARS‐5), participants' prescription withdrawals from pharmacies, and a VAS (VAS‐adherence). Hierarchical cluster analysis was performed to group patients with similar HLQ scores, and multiple linear regression analysis was performed to identify the HL dimensions that were associated with QoL and adherence to long‐term therapy. Results A total of 187 patients were included, 65% were male, and the mean (SD) age was 67 (13) years. The high‐level HL group (N = 52) had significantly better QoL than patients in the mid‐level (N = 106) and low‐level (N = 27) HL groups. The HL dimensions “actively managing health,” “actively engage with healthcare providers,” “ability to find good health information” and “ability to understand health information” were predictive of QoL and adherence to long‐term therapy. Conclusion HL seems to be important for both QoL and adherence to long‐term therapy.

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Association between medication adherence and clinical outcomes in patients with chronic kidney disease: a prospective cohort study

Abstract: The findings suggest that CKD patients with poor medication adherence are more likely to have progression of CKD. Health care providers should acknowledge these findings and provide effective strategies to deal with this issue.

Cited by 48 publications

References 22 publications

Self-reported Medication Adherence and CKD Progression

Self-reported Medication Adherence and CKD Progression

Associations with Wellbeing and Medication Adherence in Young Adults Receiving Kidney Replacement Therapy

Health Literacy in Kidney Disease: Associations with Quality of Life and Adherence

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