Potentially modifiable factors associated with non-adherence to phosphate binder use in patients on hemodialysis

Abstract

BackgroundDespite the evidence that phosphate binder (PB) is associated with improved outcomes many hemodialysis patients do not adhere to prescribed PB regimen. Therefore, barriers to PB adherence should be identified and eliminated. The purpose of this study was to evaluate PB adherence among hemodialysis patients and to explore potentially modifiable factors associated with low PB adherence.MethodsA cross-sectional study (502 patients) was performed in four dialysis units in Salvador, Brazil, using data from the second phase of the Prospective Study of the Prognosis of Chronic Hemodialysis Patients (PROHEMO). Patients were categorized as adherent or non-adherent to PB based on their responses to a semi-structured questionnaire.ResultsNon-adherence to PB was observed for 65.7% of the patients. After adjustments for numerous covariates, cerebrovascular disease (odds ratio (OR), 3.30; 95% confidence interval (CI), 1.03-10.61), higher PTH (OR per each 300 pg/mL, 1.14; 95% CI, 1.01-1.28), lack of comprehension of the appropriate time to use PB (OR, 7.09; 95% CI, 2.10-23.95) and stopping PB use after feeling better (OR, 4.54; 95% CI, 1.45-14.25) or feeling worse (OR, 11.04; 95% CI, 1.79- 68.03) were significantly associated with PB non-adherence. By contrast, the adjusted odds of PB non-adherence were lower for patients with more years on dialysis (OR by each 2 years, 0.87; 95% CI, 0.80-0.95), with serum phosphorus above 5.5 mg/dL (OR, 0.53; 95% CI 0.34-0.82), who referred that were encouraged by the dialysis staff to be independent (OR, 0.52; 95% CI 0.30-0.90), and reported that the nephrologist explained how PB should be used (OR, 0.20; 95% CI 0.05-0.73).ConclusionThe results of the present study are encouraging by showing evidence that improvement in the care provided by the dialysis staff and the attending nephrologist may play an important role in reducing the high prevalence of non-adherence to PB in maintenance hemodialysis patients. A new questionnaire is presented and may help to evaluate systematically the patients regarding PB adherence in hemodialysis setting.

Factors associated with treatment adherence of Brazilian patients undergoing hemodialysis

“…Additionally, due to the high complexity of the treatment, most studies focus on the analysis of one of the treatment aspects (i.e., adherence to medication, or to fluid or diet restrictions), which hinders the establishment of general conclusions (Schmid et al, 2009;Martins et al, 2013;Alkatheri et al, 2014). This study's aim was to assess adherence to different aspects of the HD treatment of ESRD patients and identify the relationship between adherence to treatment and sociodemographic and psychological variables.…”

Novel iron-containing phosphate binders for treatment of hyperphosphatemia

“…Improved adherence with a lower pill burden is the pivotal advantage of PA21. But this advantage has to be interpreted with some caution, as i) pill burden is only one of several factors that influence adherence [68] and ii) measurement of adherence was a weak point in the trials, as stated by the authors [34]. Although methods for measuring adherence are not standardized, more sophisticated techniques such as medication event monitoring systems could help to further substantiate the reported adherence data.…”

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“…Sabaté (2003) has ranked potential non-adherence factors in five categories: Treatment-related, disease-related, health-system related and finally, socio-economic [8]. More specifically, in the international literature the causes of non-compliance may be the beliefs of the patient [9], the poor relationship between a healthcare professional and a patient [10] the personality of the patient [11], the educational level or economic reasons [12]. Most of these studies agree that all potential determinants should be considered in order to improve the patient's ability to follow the treatment regimen.…”