title: Self-reported Medication Adherence and Adverse Patient Safety Events in CKD.
abstract: BACKGROUND
  Promoting medication adherence is a recognized challenge for prescribers. In this study, we examine whether lower medication adherence is associated with adverse safety events in individuals with decreased estimated glomerular filtration rates (eGFRs).
  
  
  METHODS
  Cross-sectional baseline analysis of prospective cohort.
  
  
  METHODS
  Baseline analysis of the Safe Kidney Care (SKC) Cohort Study, a prospective study of individuals with eGFRs<60 mL/min/1.73 m(2) intended to assess the incidence of disease-specific safety events. Kidney transplant recipients were excluded.
  
  
  METHODS
  Self-reported medication adherence based on responses to 3 questions ascertaining degree of medication regimen adherence.
  
  
  RESULTS
  Adverse safety events were self-reported at baseline (class I events), such as hypoglycemia or fall thought to be related to a medication, or detected incidentally during the baseline visit (class II events), for example, hypotension or hyperkalemia. Potential drug-related problems (DRPs) were determined by analyzing participants' medications with respect to dosing guidelines based on their screening eGFRs at the time of medication reporting.
  
  
  METHODS
  Relationship between medication adherence and disease-specific patient safety events.
  
  
  RESULTS
  Of 293 SKC participants, 154 (53%) were classified as having lower medication adherence. After multivariable adjustment, lower medication adherence was significantly associated with a class I or II safety event (prevalence ratio [PR], 1.21; 95% CI, 1.04-1.41) and potential DRPs (PR, 1.29; 95% CI, 1.02-1.63). Lower medication adherence was also significantly associated with multiple (≥2) class I events (PR, 1.71; 95% CI, 1.18-2.49), multiple class I or II events (PR, 1.35; 95% CI, 1.04-1.76), and multiple potential DRPs (PR, 2.11; 95% CI, 1.08-2.69) compared with those with higher medication adherence.
  
  
  CONCLUSIONS
  Use of self-reported medication adherence rather than pharmacy records. Clinical relevance of detected safety events is unclear.
  
  
  CONCLUSIONS
  Lower medication adherence is associated with adverse safety events in individuals with eGFRs<60 mL/min/1.73 m(2).
authors.affiliation: Department of Medicine, University of Maryland School of Medicine, Baltimore, MD.
authors.forename: Kailin L
authors.initials: KL
authors.lastname: Hsu
authors.affiliation: Department of Medicine, University of Maryland School of Medicine, Baltimore, MD; Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD; Department of Medicine, Veterans Affairs Maryland Health Care System, Baltimore, MD.
authors.forename: Jeffrey C
authors.initials: JC
authors.lastname: Fink
authors.affiliation: Department of Medicine, University of Maryland School of Medicine, Baltimore, MD.
authors.forename: Jennifer S
authors.initials: JS
authors.lastname: Ginsberg
authors.affiliation: Department of Medicine, University of Maryland School of Medicine, Baltimore, MD.
authors.forename: Marni
authors.initials: M
authors.lastname: Yoffe
authors.affiliation: Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD.
authors.forename: Min
authors.initials: M
authors.lastname: Zhan
authors.affiliation: Department of Medicine, University of Maryland School of Medicine, Baltimore, MD.
authors.forename: Wanda
authors.initials: W
authors.lastname: Fink
authors.affiliation: University of Maryland School of Pharmacy, Baltimore, MD.
authors.forename: Corinne M
authors.initials: CM
authors.lastname: Woods
authors.affiliation: Department of Medicine, Duke University School of Medicine, Durham, NC; Department of Medicine, Durham Veterans Affairs Medical Center, Durham, NC. Electronic address: clarissa.diamantidis@duke.edu.
authors.forename: Clarissa J
authors.initials: CJ
authors.lastname: Diamantidis
mesh_terms: D000368:Aged; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D004359:Drug Therapy, Combination; D064420:Drug-Related Side Effects and Adverse Reactions; D005260:Female; D005919:Glomerular Filtration Rate / Q000502:physiology; D006801:Humans; D007677:Kidney Function Tests; D008297:Male; D008875:Middle Aged; D061214:Patient Safety / Q000706:statistics & numerical data*; D016012:Poisson Distribution; D011446:Prospective Studies; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis* / Q000188:drug therapy*; D057566:Self Report; D012720:Severity of Illness Index; D016903:Drug Monitoring
keywords: Reduced kidney function; Safe Kidney Care (SKC) Cohort Study; adverse safety event; chronic kidney disease (CKD); drug-related problem (DRP); medication adherence; patient safety; polypharmacy; treatment compliance