W TESFAYE1, R CASTELINO2, B WIMMER1, C MCKERCHER3, M JOSE1,3,4, G PETERSON1, S ZAIDI1
1School of Medicine, University Of Tasmania, Sandy Bay, Australia, 2The University of Sydney, Sydney, Australia, 3Menzies Institute for Medical Research, Hobart, Australia, 4Renal Unit, Royal Hobart Hospital, Hobart, Australia
Aim: To evaluate the prevalence and correlates of medication non-adherence in adults with advanced chronic kidney disease (CKD) not receiving renal replacement therapy.
Background: The complexity of CKD typically necessitates the use of multiple medications, posing a risk of poor medication adherence. However, little has been published about factors affecting medication adherence in advanced CKD patients not receiving dialysis.
Methods: Seventy-eight adults (33% women) with advanced CKD (eGFR <30 ml/min/1.73 m2) and not receiving dialysis were recruited through their treating physicians (general practitioners and nephrologists). Medication adherence was self-reported by study participants. Estimated glomerular filtration rate (eGFR), modified Charlson’s comorbidity index (CCI), level of autonomy, activities of daily living, the presence of depression, cognitive function and sociodemographic variables were included for multivariate analyses. Binary logistic regression was used to identify factors independently associated with poor medication adherence.
Results: The median (interquartile range) age of the study participants was 73.5 (65.5-80.7) years. Overall, 649 medications were prescribed and the mean (SD) number of medications per participant was 8.3 (3.5). Overall, 35 (45%) participants were considered non-adherent. Multivariate analyses indicated that younger age (OR 0.93 per year increase, 95% CI 0.87-0.99; p<0.05) and male gender (OR 0.15, 95% CI 0.03-0.75; p<0.05) were associated with poor medication adherence after adjusting for the number of medications, activities of daily living, modified CCI, eGFR, patient level of autonomy, cognitive function and depression.
Conclusions: A considerable proportion of the participants self-reported poor medication adherence. Men and younger participants were more likely to report poor adherence. Following up of these patients will enable us to determine the impact of medication non-adherence on clinical outcomes and health-related quality of life.