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Kidney Int Rep. 2018 Feb 2;3(3):645-651. doi: 10.1016/j.ekir.2018.01.007. eCollection 2018 May.

Self-reported Medication Adherence and CKD Progression.

Author information

1
Department of Medicine, University of Illinois at Chicago, Chicago, Ilinois, USA.
2
Department of Medicine, Jesse Brown VAMC, Chicago, Illinois, USA.
3
Research Service, Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr., VA Hospital, Hines, Illinois, USA.
4
Department of Medicine and Epidemiology, Tulane University, New Orleans, Louisiana, USA; Research Division, Ochsner Health System, New Orleans, Louisiana, USA.
5
National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA.
6
Department of Medicine, University of Arizona, Phoenix, Arizona, USA.
7
Department of Internal Medicine, Wayne State University, Detroit, Michigan, USA.
8
Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA.
9
Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.

Abstract

Introduction:

In the general population, medication nonadherence contributes to poorer outcomes. However, little is known about medication adherence among adults with chronic kidney disease (CKD). We evaluated the association of self-reported medication adherence with CKD progression and all-cause death in patients with CKD.

Methods:

In this prospective observational study of 3305 adults with mild-to-moderate CKD enrolled in the Chronic Renal Insufficiency Cohort (CRIC) Study, the baseline self-reported medication adherence was assessed by responses to 3 questions and categorized as high, medium, and low. CKD progression (50% decline in eGFR or incident end-stage renal disease) and all-cause death were measured using multivariable Cox proportional hazards.

Results:

Of the patients, 68% were categorized as high adherence, 17% medium adherence, and 15% low adherence. Over a median follow-up of 6 years, there were 969 CKD progression events and 675 deaths. Compared with the high-adherence group, the low-adherence group experienced increased risk for CKD progression (hazard ratio = 1.27, 95% confidence interval = 1.05, 1.54) after adjustment for sociodemographic and clinical factors, cardiovascular medications, number of medication types, and depressive symptoms. A similar association existed between low adherence and all-cause death, but did not reach standard statistical significance (hazard ratio = 1.14 95% confidence interval = 0.88, 1.47).

Conclusion:

Baseline self-reported low medication adherence was associated with an increased risk for CKD progression. Future work is needed to better understand the mechanisms underlying this association and to develop interventions to improve adherence.

KEYWORDS:

CKD; death; medication adherence; progression

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