Murali K1,2, Mullan J2, Roodenrys S2, Cheikh Hassan H1,2, Lonergan M1,2

1Wollongong Hospital, Wollongong, Australia, 2University of Wollongong, Wollongong, Australia

Aim: Identify independent contributors to medication non-adherence in chronic kidney disease (CKD) and end-stage kidney disease (ESKD) patients on dialysis.

Background: Medication non-adherence is common in chronic diseases. CKD and ESKD patients are vulnerable due to greater pill burden and treatment complexity. Identification of independent contributors may enable development of management strategies to address non-adherence.

Methods: Cross-sectional design. In a cohort of non-dialysis CKD and ESKD patients on dialysis we assessed medication non-adherence (using validated self-reported scale), demographic factors, comorbidities, pill burden, cognitive function (using modified mini-mental state test, Trail-making test part A&B & Stroop task), health literacy (HL) (using a 44-item questionnaire constituting 9 scales – HLQ), and depression (using Beck depression inventory 2). Independent association between treatment non-adherence and potential contributors assessed using multivariate ordinal logistic regression (LR) after exploratory univariate LR was used to identify variables to be included in the multivariable model.

Results:  Compared to CKD (N=113) patients, ESKD dialysis patients (N=107) were significantly younger (65.3±12.1 vs 68.0±11.0years), had lower annual income, higher vascular disease burden and heavier pill burden (median 21 vs 9 pills daily). In multivariate LR analysis, non-adherence was significantly associated with younger age (OR0.65 for older age, p=0.002), ESKD status (OR1.82, p=0.044), lower HL relevant to patient-health care provider engagement (HLQ6) (OR2.33, p=0.023) and depression (OR2.52, p=0.008). When pill burden was included in the multivariate model, ESKD status was not significantly associated with non-adherence (OR1.88, p=0.084), but age, HLQ6 and depression retained independent associations.

Conclusion: Medication non-adherence is significantly worse in ESKD patients and likely driven by heavier pill burden. Strategies to improve non-adherence should target younger patients, implement strategies to enhance patient-provider engagement and address depression.


Dr. Karumathil Murali is a senior nephrologist in Wollongong hospital and is a clinical associate professor in University of Wollongong.

He is actively involved in teaching medical students, junior medical officers and advanced trainees.

His field of research includes the impact of health literacy and cognitive function on treatment adherence and strategies to improve treatment adherence in patients with kidney disease including dialysis patients.

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