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Published ahead of print on May 7, 2009
Clinical Journal of the American Society of Nephrology
© 2009 American Society of Nephrology
doi: 10.2215/CJN.00290109
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Received January 16, 2009
Accepted on March 15, 2009

ORIGINAL ARTICLES

Pill Burden, Adherence, Hyperphosphatemia, and Quality of Life in Maintenance Dialysis Patients

Yi-Wen Chiu *{dagger}, Isaac Teitelbaum {ddagger}, Madhukar Misra {sect}, Essel Marie de Leon *, Tochi Adzize *, and Rajnish Mehrotra *||1

*Los Angeles Biomedical Research Institute, Torrance, California; {dagger}Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; {ddagger}University of Colorado, Denver, Colorado; {sect}University of Missouri-Columbia, Columbia, Missouri; ||Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California


1 To whom correspondence should be addressed. E-mail: rmehrotra{at}labiomed.org.


  Abstract

Background and objectives: Dialysis patients have a high burden of co-existing diseases, poor health-related quality of life (HR-QOL), and are prescribed many medications. There are no data on daily pill burden and its relationship to HR-QOL and adherence to therapy.

Design, setting, participants, & measurements: Two hundred and thirty-three prevalent, chronic dialysis patients from three units in different geographic areas in the United States underwent a single, cross-sectional assessment of total daily pill burden and that from phosphate binders. HR-QOL, adherence to phosphate binders, and serum phosphorus levels were the three main outcome measures studied.

Results: The median daily pill burden was 19; in one-quarter of subjects, it exceeded 25 pills/d. Higher pill burden was independently associated with lower physical component summary scale scores on HR-QOL on both univariate and multivariate analyses. Phosphate binders accounted for about one-half of the daily pill burden; 62% of the participants were nonadherent. There was a modest relationship between pill burden from phosphate binders and adherence and serum phosphorus levels; these associations persisted on multivariate analyses. There was no relationship between adherence and serum phosphorus levels.

Conclusions: The daily pill burden in dialysis patients is one of the highest reported to date in any chronic disease state. Higher pill burden is associated with lower HR-QOL. There are many reasons for uncontrolled serum phosphorus levels; increasing the number of prescribed pills does not seem to improve control and may come at the cost of poorer HR-QOL.




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