title: Medication treatment complexity and adherence in children with CKD.
abstract: OBJECTIVE
  The complexity of CKD management in children is increased by the number of comorbid conditions. This study assessed the prevalence of comorbidities in pediatric CKD and the frequency with which multiple comorbidities present together by assessing prevalent medication use by CKD stage and diagnosis and their association with clinical or sociodemographic factors. The association between number and frequency of dosing of medications prescribed and self-report of nonadherence was also assessed.
  
  
  METHODS
  In this cross-sectional analysis of the Chronic Kidney Disease in Children study, medication use at study entry grouped by indication was examined by CKD stage, diagnosis, age, race, ethnicity, income, and CKD duration. Multivariate adjusted predictors of medication use and clustering were examined. Nonadherence was assessed by self-report of missed medications in the past 7 days.
  
  
  RESULTS
  The 558 eligible participants had a median age of 11 years and median GFR of 44 ml/min per 1.73 m(2); 62% of participants were male and 78% had nonglomerular kidney disease. The number of medications for treatment of CKD comorbidities increased with advanced CKD stage (2.5-fold for stages IV versus II; P<0.001) and glomerular disease (1.4-fold versus nonglomerular; P<0.001). Three distinct medication clusters were identified that corresponded to treatment of glomerular disease, advanced renal tubular dysfunction, and proteinuric complications, respectively. Nonadherence was associated with increased medication dosing frequency (administration >2 times/d; P<0.001) but not the number of medications.
  
  
  CONCLUSIONS
  Medical therapy for children with CKD is complex and is affected by glomerular diagnosis, CKD stage, and medication frequency. The need for CKD-related medication treatment cannot be easily predicted by CKD staging alone. Poorer adherence was associated with increased medication frequency, but not with the number of medical problems needing treatment. Consolidating medical treatment and reducing medication frequency may improve adherence rates in children with CKD.
authors.affiliation: Due to the number of contributing authors, the affiliations are provided in the Supplemental Material.
authors.forename: Tom D
authors.initials: TD
authors.lastname: Blydt-Hansen
authors.forename: Christopher B
authors.initials: CB
authors.lastname: Pierce
authors.forename: Yi
authors.initials: Y
authors.lastname: Cai
authors.forename: Dmitri
authors.initials: D
authors.lastname: Samsonov
authors.forename: Susan
authors.initials: S
authors.lastname: Massengill
authors.forename: Marva
authors.initials: M
authors.lastname: Moxey-Mims
authors.forename: Bradley A
authors.initials: BA
authors.lastname: Warady
authors.forename: Susan L
authors.initials: SL
authors.lastname: Furth
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior; D000367:Age Factors; D002648:Child; D002652:Child Behavior; D002675:Child, Preschool; D016000:Cluster Analysis; D015897:Comorbidity; D003430:Cross-Sectional Studies; D004334:Drug Administration Schedule; D005260:Female; D005919:Glomerular Filtration Rate / Q000187:drug effects; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007223:Infant; D007668:Kidney / Q000187:drug effects* / Q000503:physiopathology; D008297:Male; D055118:Medication Adherence; D015999:Multivariate Analysis; D009656:North America / Q000453:epidemiology; D016017:Odds Ratio; D019338:Polypharmacy; D015995:Prevalence; D011446:Prospective Studies; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology / Q000503:physiopathology; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors