title: Medication adherence and growth in children with CKD.
abstract: OBJECTIVE
  Poor growth is a consequence of CKD, but can often be partially or fully prevented or corrected with the use of a number of medications. The extent of nonadherence with medications used to treat or mitigate growth failure in CKD has not been examined prospectively in children with CKD.
  
  
  METHODS
  The prevalence of both prescription of and nonadherence to recombinant human growth hormone (rhGH), phosphate binders, alkali, active vitamin D, nutritional vitamin D, iron, and erythrocyte-stimulating agents was summarized over the first seven visits of the Chronic Kidney Disease in Children cohort study. The association between self-reported nonadherence to each medication group and the mean annual change in age- and sex-specific height z score was quantified using seven separate linear regression models with generalized estimating equations.
  
  
  RESULTS
  Of 834 participants, 597 reported use of at least one of these medication groups and had adherence data available. Nonadherence ranged from 4% over all visits for erythrocyte-stimulating agents to 22% over all visits for nutritional vitamin D. Of the study participants, 451 contributed data to at least one of the analyses of adherence and changes in height z score. Children nonadherent to rhGH had no change in height z score, whereas those adherent to rhGH had a significant improvement of 0.16 SDs (95% confidence interval, 0.05 to 0.27); the effect size was slightly larger and remained significant after adjustment. Among participants with height≤3rd percentile and after adjustment, adherence to rhGH was associated with a 0.33 SD (95% confidence interval, 0.10 to 0.56) greater change in height z score. Nonadherence with other medication groups was not significantly associated with a change in height z score.
  
  
  CONCLUSIONS
  Self-reported nonadherence to rhGH was associated with poorer growth velocity in children with CKD, suggesting an opportunity for intervention and improved patient outcome.
authors: Due to the number of contributing authors, the affiliations are provided in the Supplemental Material. oakchuri@montefiore.org.
authors: Oleh M
authors: OM
authors: Akchurin
authors: Due to the number of contributing authors, the affiliations are provided in the Supplemental Material.
authors: Michael F
authors: MF
authors: Schneider
authors: Due to the number of contributing authors, the affiliations are provided in the Supplemental Material.
authors: Lucy
authors: L
authors: Mulqueen
authors: Due to the number of contributing authors, the affiliations are provided in the Supplemental Material.
authors: Ellen R
authors: ER
authors: Brooks
authors: Due to the number of contributing authors, the affiliations are provided in the Supplemental Material.
authors: Craig B
authors: CB
authors: Langman
authors: Due to the number of contributing authors, the affiliations are provided in the Supplemental Material.
authors: Larry A
authors: LA
authors: Greenbaum
authors: Due to the number of contributing authors, the affiliations are provided in the Supplemental Material.
authors: Susan L
authors: SL
authors: Furth
authors: Due to the number of contributing authors, the affiliations are provided in the Supplemental Material.
authors: Marva
authors: M
authors: Moxey-Mims
authors: Due to the number of contributing authors, the affiliations are provided in the Supplemental Material.
authors: Bradley A
authors: BA
authors: Warady
authors: Due to the number of contributing authors, the affiliations are provided in the Supplemental Material.
authors: Frederick J
authors: FJ
authors: Kaskel
authors: Due to the number of contributing authors, the affiliations are provided in the Supplemental Material.
authors: Amy L
authors: AL
authors: Skversky
mesh_terms: D000293:Adolescent; D002648:Child; D005260:Female; D006130:Growth Disorders / Q000188:drug therapy* / Q000209:etiology*; D006801:Humans; D008297:Male; D011446:Prospective Studies; D051436:Renal Insufficiency, Chronic / Q000150:complications*; D016903:Drug Monitoring
keywords: CKD; children; pediatric nephrology