title: Phosphate binder pill burden, patient-reported non-adherence, and mineral bone disorder markers: Findings from the DOPPS.
abstract: Because of multiple comorbidities, hemodialysis (HD) patients are prescribed many oral medications, including phosphate binders (PBs), often resulting in a high "pill burden." Using data from the international Dialysis Outcomes and Practice Patterns Study (DOPPS), we assessed associations between PB pill burden, patient-reported PB non-adherence, and levels of serum phosphorus (SPhos) and parathyroid hormone (PTH) using standard regression analyses. The study included data collected from 5262 HD patients from dialysis units participating in the DOPPS in 12 countries. PB prescription ranged from a mean of 7.4 pills per day in the United States to 3.9 pills per day in France. About half of the patients were prescribed at least 6 PB pills per day, and 13% were prescribed at least 12 PB pills per day. Overall, the proportion of patients who reported skipping PBs at least once in the past month was 45% overall, ranging from 33% in Belgium to 57% in the United States. There was a trend toward greater PB non-adherence and a higher number of prescribed PB pills per day. Non-adherence to PB prescription was associated with high SPhos (>5.5 mg/dL) and PTH (>600 pg/mL). Adherence to PB is a challenge for many HD patients and may be related to the number of PB pills prescribed. Prescription of a simplified PB regimen could improve patient adherence and perhaps improve SPhos and PTH levels.
authors.affiliation: Vanderbilt University Medical Center, Nashville, Tennessee, USA.
authors.forename: Rachel B
authors.initials: RB
authors.lastname: Fissell
authors.affiliation: Arbor Research Collaborative for Health, Ann Arbor, Michigan, USA.
authors.forename: Angelo
authors.initials: A
authors.lastname: Karaboyas
authors.affiliation: Arbor Research Collaborative for Health, Ann Arbor, Michigan, USA.
authors.forename: Brian A
authors.initials: BA
authors.lastname: Bieber
authors.affiliation: University of Michigan, Ann Arbor, Michigan, USA.
authors.forename: Ananda
authors.initials: A
authors.lastname: Sen
authors.affiliation: Arbor Research Collaborative for Health, Ann Arbor, Michigan, USA.|University of Michigan, Ann Arbor, Michigan, USA.
authors.forename: Yun
authors.initials: Y
authors.lastname: Li
authors.affiliation: Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Bahia, Brazil.
authors.forename: Antonio A
authors.initials: AA
authors.lastname: Lopes
authors.affiliation: Tokyo Women's Medical University, Tokyo, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Akiba
authors.affiliation: Dialysezentrum Heidelberg, Heidelberg, Germany.
authors.forename: Jürgen
authors.initials: J
authors.lastname: Bommer
authors.affiliation: Center Hospital de University of Montreal, Montreal, Quebec, Canada.
authors.forename: Jean
authors.initials: J
authors.lastname: Ethier
authors.affiliation: Cliniques St Luc, Université Catholique de Louvain, Brussels, Belgium.
authors.forename: Michel
authors.initials: M
authors.lastname: Jadoul
authors.affiliation: Arbor Research Collaborative for Health, Ann Arbor, Michigan, USA.
authors.forename: Ronald L
authors.initials: RL
authors.lastname: Pisoni
authors.affiliation: Arbor Research Collaborative for Health, Ann Arbor, Michigan, USA.|University of Michigan, Ann Arbor, Michigan, USA.
authors.forename: Bruce M
authors.initials: BM
authors.lastname: Robinson
authors.affiliation: Vanderbilt University Medical Center, Nashville, Tennessee, USA.|Arbor Research Collaborative for Health, Ann Arbor, Michigan, USA.
authors.forename: Francesca
authors.initials: F
authors.lastname: Tentori
mesh_terms: D000368:Aged; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008903:Minerals; D017063:Outcome Assessment, Health Care; D010349:Patient Compliance / Q000523:psychology*; D010710:Phosphates; D010758:Phosphorus / Q000097:blood*; D011446:Prospective Studies; D006435:Renal Dialysis / Q000009:adverse effects
chemical_list: D008903:Minerals; D010710:Phosphates; D010758:Phosphorus
keywords: Adherence; mineral bone disorder; phosphate binders; pill burden