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


METHODS
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.


RESULTS
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.


CONCLUSIONS
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.
Los Angeles Biomedical Research Institute, Torrance, California, USA.
Yi-Wen
YW
Chiu
Isaac
I
Teitelbaum
Madhukar
M
Misra
Essel Marie
EM
de Leon
Tochi
T
Adzize
Rajnish
R
Mehrotra
D000328:Adult; D000368:Aged; D015331:Cohort Studies; D015897:Comorbidity; D017281:Cost of Illness; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D054559:Hyperphosphatemia / Q000188:drug therapy* / Q000453:epidemiology / Q000523:psychology*; D007676:Kidney Failure, Chronic / Q000453:epidemiology / Q000523:psychology* / Q000628:therapy; D008297:Male; D055118:Medication Adherence / Q000523:psychology*; D008875:Middle Aged; D015999:Multivariate Analysis; D010758:Phosphorus / Q000097:blood; D011237:Predictive Value of Tests; D015995:Prevalence; D011788:Quality of Life; D006435:Renal Dialysis / Q000523:psychology*; D012680:Sensitivity and Specificity; D016903:Drug Monitoring
D010758:Phosphorus