title: A systematic review of the prevalence and determinants of nonadherence to phosphate binding medication in patients with end-stage renal disease.
abstract: BACKGROUND
  Cardiovascular events are the leading cause of death in end stage renal disease (ESRD). Adherence to phosphate binding medication plays a vital role in reducing serum phosphorus and associated cardiovascular risk. This poses a challenge for patients as the regimen is often complex and there may be no noticeable impact of adherence on symptoms. There is a need to establish the level of nonadherence to phosphate binding medication in renal dialysis patients and identify the factors associated with it.
  
  
  METHODS
  The online databases PsycINFO, Medline, Embase and CINAHL were searched for quantitative studies exploring predictors of nonadherence to phosphate binding medication in ESRD. Rates and predictors of nonadherence were extracted from the papers.
  
  
  RESULTS
  Thirty four studies met the inclusion criteria. There was wide variation in reported rates of non-adherence (22-74% patients nonadherent, mean 51%). This can be partially attributed to differences in the way adherence has been defined and measured. Demographic and clinical predictors of nonadherence were most frequently assessed but only younger age was consistently associated with nonadherence. In contrast psychosocial variables (e.g. patients' beliefs about medication, social support, personality characteristics) were less frequently assessed but were more likely to be associated with nonadherence.
  
  
  CONCLUSIONS
  Nonadherence to phosphate binding medication appears to be prevalent in ESRD. Several potentially modifiable psychosocial factors were identified as predictors of nonadherence. There is a need for further, high-quality research to explore these factors in more detail, with the aim of informing the design of an intervention to facilitate adherence.
authors.affiliation: Centre for Behavioural Medicine, The School of Pharmacy, University of London, Mezzanine Floor, BMA House, Tavistock Square, London WC1H 9JP, UK. psy77ck@yahoo.com
authors.forename: Christina
authors.initials: C
authors.lastname: Karamanidou
authors.forename: Jane
authors.initials: J
authors.lastname: Clatworthy
authors.forename: John
authors.initials: J
authors.lastname: Weinman
authors.forename: Rob
authors.initials: R
authors.lastname: Horne
mesh_terms: D006801:Humans; D007676:Kidney Failure, Chronic / Q000188:drug therapy* / Q000453:epidemiology* / Q000523:psychology; D010349:Patient Compliance / Q000523:psychology; D004364:Pharmaceutical Preparations / Q000008:administration & dosage*; D028044:Phosphate-Binding Proteins / Q000378:metabolism*; D015995:Prevalence; D012959:Socioeconomic Factors
chemical_list: D004364:Pharmaceutical Preparations; D028044:Phosphate-Binding Proteins