title: Barriers to medication adherence and its relationship with outcomes in pediatric dialysis patients.
abstract: BACKGROUND
  Medication adherence is a major factor determining outcome in children with chronic disease. Children with end-stage renal disease are challenged with requirements for renal replacement therapy in addition to complicated medication regimens.
  
  
  METHODS
  We assessed barriers to medication adherence in 22 pediatric patients receiving chronic dialysis [63.6 % hemodialysis (HD), 36.4 % peritoneal dialysis (PD); age 15.9 ± 0.7 years, dialysis vintage 31.6 ± 6.5 months]. Adherence was assessed by a 16-question survey with a maximum score (difficulty) of 64.
  
  
  RESULTS
  The overall mean adherence score was 30.9 ± 2.4 (range 16-49; median  27.5). There was a trend for lower adherence scores in patients on HD (27.5 ± 2.9) compared to those on PD (36.8 ± 3.7) (p = 0.06). Compared to HD patients, the mean score/question was significantly higher in PD patients (1.7 ± 0.2 vs. 2.4 ± 0.2, respectively; p = 0.006). Of the 16 questions, HD and PD patients gave a mean response of ≤1.2 for five and zero questions, respectively. Neither gender, age nor dialysis vintage was related to adherence scores. There was also a trend for adherence scores to be higher in females (35.6 ± 3.7) than in males (27.5 ± 2.9) (p = 0.1), but this difference did not reach statistical significance. Markers of mineral bone disease were similar in HD and PD patients. Among all targets in HD and PD patients combined, there was no relationship between adherence scores and number of targets reached (r = -0.09, p = 0.7).
  
  
  CONCLUSIONS
  There are many barriers to medication adherence in pediatric patients receiving dialysis. In our patient group the difficulties were more evident in patients receiving PD than in those receiving HD.
authors.affiliation: Office of Device Evaluation, Renal Devices Branch (RNDB), United States Food and Drug Administration, 10903 New Hampshire Avenue, Silver Spring, MD, 20903, USA, dsilverstein2001@yahoo.com.
authors.forename: Douglas M
authors.initials: DM
authors.lastname: Silverstein
authors.forename: Angela
authors.initials: A
authors.lastname: Fletcher
authors.forename: Kathleen
authors.initials: K
authors.lastname: Moylan
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008297:Male; D010530:Peritoneal Dialysis / Q000706:statistics & numerical data*; D019999:Pharmaceutical Solutions; D006435:Renal Dialysis / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D013607:Tablets; D016896:Treatment Outcome; D055815:Young Adult; D016903:Drug Monitoring
chemical_list: D019999:Pharmaceutical Solutions; D013607:Tablets