title: Predialysis Cardiovascular Disease Medication Adherence and Mortality After Transition to Dialysis.
abstract: BACKGROUND
  Medication nonadherence is a known risk factor for adverse outcomes in the general population. However, little is known about the association of predialysis medication adherence among patients with advanced chronic kidney disease and mortality following their transition to dialysis.
  
  
  METHODS
  Observational study.
  
  
  METHODS
  32,348 US veterans who transitioned to dialysis during 2007 to 2011.
  
  
  METHODS
  Adherence to treatment with cardiovascular drugs, ascertained from pharmacy database records using proportion of days covered (PDC) and persistence during the predialysis year.
  
  
  RESULTS
  Post-dialysis therapy initiation all-cause and cardiovascular mortality, using Cox models with adjustment for confounders.
  
  
  RESULTS
  Mean age of the cohort was 72±11 (SD) years; 96% were men, 74% were white, 23% were African American, and 69% had diabetes. During a median follow-up of 23 (IQR, 9-36) months, 18,608 patients died. Among patients with PDC>80%, there were 14,006 deaths (mortality rate, 283 [95% CI, 278-288]/1,000 patient-years]); among patients with PDC>60% to 80%, there were 3,882 deaths (mortality rate, 294 [95% CI, 285-304]/1,000 patient-years); among patients with PDC≤60%, there were 720 deaths (mortality rate, 291 [95% CI, 271-313]/1,000 patient-years). Compared with patients with PDC>80%, the adjusted HR for post-dialysis therapy initiation all-cause mortality for patients with PDC>60% to 80% was 1.12 (95% CI, 1.08-1.16), and for patients with PDC≤60% was 1.21 (95% CI, 1.11-1.30). In addition, compared with patients showing medication persistence, adjusted HR risk for post-dialysis therapy initiation all-cause mortality for patients with nonpersistence was 1.11 (95% CI, 1.05-1.16). A similar trend was detected for cardiovascular mortality and in subgroup analyses.
  
  
  CONCLUSIONS
  Large number of missing values; results may not be generalizable to women or the general US population.
  
  
  CONCLUSIONS
  Predialysis cardiovascular medication nonadherence is an independent risk factor for postdialysis mortality in patients with advanced chronic kidney disease transitioning to dialysis therapy. Further studies are needed to assess whether interventions targeting adherence improve survival after dialysis therapy initiation.
authors.affiliation: Division of Nephrology, University of Tennessee Health Science Center, Memphis, TN.
authors.forename: Miklos Z
authors.initials: MZ
authors.lastname: Molnar
authors.affiliation: Nephrology Section, Stratton VA Medical Center, Albany, NY; Nephrology Division, Department of Medicine, Albany Medical College, Albany, NY.
authors.forename: Elvira O
authors.initials: EO
authors.lastname: Gosmanova
authors.affiliation: Division of Nephrology, University of Tennessee Health Science Center, Memphis, TN.
authors.forename: Keiichi
authors.initials: K
authors.lastname: Sumida
authors.affiliation: Division of Nephrology, University of Tennessee Health Science Center, Memphis, TN.
authors.forename: Praveen K
authors.initials: PK
authors.lastname: Potukuchi
authors.affiliation: Division of Nephrology, University of Tennessee Health Science Center, Memphis, TN.
authors.forename: Jun Ling
authors.initials: JL
authors.lastname: Lu
authors.affiliation: Harold Simmons Center for Chronic Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California-Irvine, Orange, CA.
authors.forename: Jennie
authors.initials: J
authors.lastname: Jing
authors.affiliation: Harold Simmons Center for Chronic Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California-Irvine, Orange, CA.
authors.forename: Vanessa A
authors.initials: VA
authors.lastname: Ravel
authors.affiliation: Harold Simmons Center for Chronic Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California-Irvine, Orange, CA.
authors.forename: Melissa
authors.initials: M
authors.lastname: Soohoo
authors.affiliation: Harold Simmons Center for Chronic Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California-Irvine, Orange, CA.
authors.forename: Connie M
authors.initials: CM
authors.lastname: Rhee
authors.affiliation: Harold Simmons Center for Chronic Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California-Irvine, Orange, CA.
authors.forename: Elani
authors.initials: E
authors.lastname: Streja
authors.affiliation: Harold Simmons Center for Chronic Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California-Irvine, Orange, CA.
authors.forename: Kamyar
authors.initials: K
authors.lastname: Kalantar-Zadeh
authors.affiliation: Division of Nephrology, University of Tennessee Health Science Center, Memphis, TN; Nephrology Section, Memphis VA Medical Center, Memphis, TN. Electronic address: ckovesdy@uthsc.edu.
authors.forename: Csaba P
authors.initials: CP
authors.lastname: Kovesdy
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000150:complications / Q000188:drug therapy* / Q000401:mortality*; D005260:Female; D006801:Humans; D008297:Male; D006435:Renal Dialysis; D051436:Renal Insufficiency, Chronic / Q000150:complications / Q000628:therapy; D012307:Risk Factors; D016903:Drug Monitoring
keywords: Transition to dialysis; advanced chronic kidney disease; anti-hypertensive medications; aspirin; cardiovascular mortality; cardiovascular pharmacotherapy; drug therapy; medication adherence; medication possession ratio (MPR); mortality; pharmacy database analysis; proportion of days covered (PDC); statins; treatment compliance