Social determinants of patiromer adherence and abandonment: An observational, retrospective, real-world claims analysis

• Published in: PloS one Vol. 18; no. 3; p. e0281775
• Main Authors: Kleinman, Nathan, Kammerer, Jennifer, LaGuerre, Kevin, Thakar, Charuhas V
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 27.03.2023; Public Library of Science (PLoS)
• Subjects: Abandonment; Abnormalities; Adult; Aged; Aldosterone; Analysis; Angiotensin; Cardiac patients; Care and treatment; Chronic illnesses; Chronic kidney failure; Complex patients; Congestive heart failure; Datasets; Education; Evaluation; Evidence-based medicine; Government programs; Health services; Heart Failure - complications; Heart Failure - drug therapy; Humans; Hyperkalemia; Hyperkalemia - complications; Hyperkalemia - drug therapy; Hyperkalemia - epidemiology; Income; Independent variables; Insurance Claim Review; Kidney diseases; Male; Medicare; Medication Adherence; Medicine and Health Sciences; Patient compliance; Patient outcomes; Patients; Pharmacy; Population density; Postal codes; Poverty; Prescription drugs; Regions; Regression analysis; Renal Insufficiency, Chronic - complications; Renal Insufficiency, Chronic - drug therapy; Renin; Research and Analysis Methods; Retrospective Studies; Social Determinants of Health; Social Sciences; Statistical analysis; Subgroups; United States; Variables; United States
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0281775

Hyperkalemia is a frequent and serious complication in chronic kidney disease (CKD) that can impede continuation of beneficial evidence-based therapies. Recently, novel therapies such as patiromer have been developed to treat chronic hyperkalemia, but their optimal utility hinges on adherence. Social determinants of health (SDOH) are critically important and can impact both medical conditions and treatment prescription adherence. This analysis examines SDOH and their influence on adherence to patiromer or abandonment of prescriptions for hyperkalemia treatment. This was an observational, retrospective, real-world claims analysis of adults with patiromer prescriptions and 6- and 12-months pre- and post-index prescription data in Symphony Health's Dataverse during 2015-2020, and SDOH from census data. Subgroups included patients with heart failure (HF), hyperkalemia-confounding prescriptions, and any CKD stages. Adherence was defined as >80% of proportion of days covered (PDC) for ≥60 days and ≥6 months, and abandonment as a portion of reversed claims. Quasi-Poisson regression modeled the impact of independent variables on PDC. Abandonment models used logistic regression, controlling for similar factors and initial days' supply. Statistical significance was p<0.05. 48% of patients at 60 days and 25% at 6 months had a patiromer PDC >80%. Higher PDC was associated with older age, males, Medicare/Medicaid coverage, nephrologist prescribed, and those receiving renin-angiotensin-aldosterone system inhibitors. Lower PDC correlated with higher out-of-pocket cost, unemployment, poverty, disability, and any CKD stage with comorbid HF. PDC was better in regions with higher education and income. SDOH (unemployment, poverty, education, income) and health indicators (disability, comorbid CKD, HF) were associated with low PDC. Prescription abandonment was higher in patients with prescribed higher dose, higher out-of-pocket costs, those with disability, or designated White. Key demographic, social, and other factors play a role in drug adherence when treating life-threatening abnormalities such as hyperkalemia and may influence patient outcomes.