Pill burden, adherence, hyperphosphatemia, and quality of life in maintenance dialysis patients

• Published in: Clinical journal of the American Society of Nephrology Vol. 4; no. 6; pp. 1089 - 1096
• Main Authors: Chiu, Yi-Wen, Teitelbaum, Isaac, Misra, Madhukar, de Leon, Essel Marie, Adzize, Tochi, Mehrotra, Rajnish
• Format: Journal Article
• Language: English
• Published: United States American Society of Nephrology 01.06.2009
• Subjects: Adult; Aged; Cohort Studies; Comorbidity; Cost of Illness; Cross-Sectional Studies; Dialysis; Female; Humans; Hyperphosphatemia - drug therapy; Hyperphosphatemia - epidemiology; Hyperphosphatemia - psychology; Kidney Failure, Chronic - epidemiology; Kidney Failure, Chronic - psychology; Kidney Failure, Chronic - therapy; Male; Medication Adherence - psychology; Medication Adherence - statistics & numerical data; Middle Aged; Multivariate Analysis; Phosphorus - blood; Predictive Value of Tests; Prevalence; Quality of Life; Renal Dialysis - psychology; Sensitivity and Specificity
• ISSN: 1555-905X; 1555-9041; 1555-905X
• DOI: 10.2215/CJN.00290109

Dialysis patients have a high burden of co-existing diseases, poor health-related quality of life (HR-QOL), and are prescribed many medications. There are no data on daily pill burden and its relationship to HR-QOL and adherence to therapy. Two hundred and thirty-three prevalent, chronic dialysis patients from three units in different geographic areas in the United States underwent a single, cross-sectional assessment of total daily pill burden and that from phosphate binders. HR-QOL, adherence to phosphate binders, and serum phosphorus levels were the three main outcome measures studied. The median daily pill burden was 19; in one-quarter of subjects, it exceeded 25 pills/d. Higher pill burden was independently associated with lower physical component summary scale scores on HR-QOL on both univariate and multivariate analyses. Phosphate binders accounted for about one-half of the daily pill burden; 62% of the participants were nonadherent. There was a modest relationship between pill burden from phosphate binders and adherence and serum phosphorus levels; these associations persisted on multivariate analyses. There was no relationship between adherence and serum phosphorus levels. The daily pill burden in dialysis patients is one of the highest reported to date in any chronic disease state. Higher pill burden is associated with lower HR-QOL. There are many reasons for uncontrolled serum phosphorus levels; increasing the number of prescribed pills does not seem to improve control and may come at the cost of poorer HR-QOL.