Factors affecting medication adherence among pre-dialysis chronic kidney disease patients: a systematic review and meta-analysis of literature

The Effect of Biopsychosocial-Spiritual Factors on Medication Adherence in Chronic Diseases in Turkey Using Structural Equation Modeling

This study was to examine the factors associated with medication adherence in individuals with chronic diseases within the concept of the biopsychosocial-spiritual model. A cross-sectional study design was used. A total of 837 patients diagnosed with chronic diseases were included in this study between November 2022 and December 2023. Data were collected based on the biopsychosocial-spiritual model. Medication adherence level was evaluated with the "Medication Adherence Report Scale." "Hospital Anxiety Depression Scale," "Multidimensional Perceived Social Support Scale," and "Spiritual Well-Being Scale" were used to evaluate the psychological, social, and spiritual dimensions. Data were analyzed using descriptive statistics and a multiple linear regression model. Anxiety, social support status, and spiritual status were important correlates of medication adherence levels in individuals with chronic diseases. It was determined that variables such as age, gender, and number of chronic diseases did not affect medication adherence. Medication adherence in individuals with chronic diseases is significantly associated with psychological, social, and spiritual factors. Therefore, when evaluating medication adherence, it should not be forgotten that it is a multifaceted concept and individuals should also be evaluated from psychological, social, and spiritual perspectives.

Critical Review of the Benefit from Early Pharmacological and Dietary Support for Patients with Moderate-to-Severe (Non-Terminal) Chronic Kidney Disease

Moderate-to-severe chronic kidney disease (CKD) is a public health problem affecting hundreds of millions of people around the world. Started early, nephroprotection measures are able to prevent the degradation of renal function and are a major issue in CKD management. This approach consists of a combination of pharmacological and non-pharmacological treatments aimed at slowing down the decline in renal filtration capacity and improving patient well-being. Drugs such as angiotensin-converting enzyme inhibitors, angiotensin II receptor antagonists, and sodium-glucose cotransport type 2 inhibitors play a crucial role in reducing intraglomerular pressure and renal inflammation. Their beneficial effects are potentiated when they are combined with non-pharmacological approaches, such as salt and protein restriction. This present review provides a critical overview of the current pharmacological and nutritional therapies that may slow down the progression of CKD. Recently, many pharmacological treatments have opened up new perspectives for managing this condition. Nevertheless, prevention remains the cornerstone of effective disease management. Actually, very few studies include both pharmacists and dietitians in their interdisciplinary team mainly represented by nephrologists, nurses, and social workers. However, their specific collaboration may significantly improve the knowledge and skills to help patients in their own CKD management. Future research is required to assess the benefit of collaboration in supporting patients with moderate-to-severe CKD before any concern of renal replacement therapy (RRT).

Perspectives of medication-related experiences in Black persons with kidney diseases: The patient voice

PURPOSE

Black persons comprise 13.4% of the US population but represent 36% of those with kidney failure. Medication-related disparities likely contribute to these outcomes. Patient perspective provides valuable insight into what they need and want from their medications and their care.

METHODS

We conducted five 1.25-hour online focus group sessions via a videoconferencing app between March 30 and June 27, 2022. Our nationally recruited sample consisted of 19 adults 37 to 72 years of age who represented a broad range of educational backgrounds, all with CKD (non-dialysis-dependent, dialysis-dependent, or post kidney transplant). Semistructured guides were constructed by our team and used by moderators. Inductive thematic analysis procedures were followed. Patients representative of our study population were integral members of our research team.

RESULTS

Our analysis includes 3 major themes and associated subthemes: (1) meet patients where they are (subthemes: patient autonomy and empowerment, experience with illness, home and community support, barriers to understanding, and barriers to access; (2) the patient journey with medications (subthemes: fears with medications, frustrations and burdens with medication use, adjusting to medications, desire for awareness and explanation, preferences with medications, and helpful tools and supports; and (3) significant interactions with healthcare professionals (subthemes: barriers to building trust, type of care and interactions desired, and care team communication).

CONCLUSION

Recognizing the patient as an individual, addressing their frustrations and needs with medications, and attending to implicit biases and strategies to overcome barriers and empower Black persons with CKD are anticipated to reduce medication- related disparities and improve health outcomes experienced by this population.

Sick Day Management Plans for Aboriginal and/or Torres Strait Islander Peoples With Chronic Kidney Disease on the Cape York Peninsula of Australia: Health Workers' Perspectives

OBJECTIVE

This study aimed to explore the perspectives of healthcare professionals on the utility of sick day management plans for people with chronic kidney disease (CKD) in remote communities and collaboratively design a sick day management plan resource.

DESIGN

This qualitative study utilised two phases of data collection: preliminary observational data and semi-structured interviews. The research design and analysis were guided by the normalisation process theory (NPT) framework, tailored for complex interventions in healthcare.

SETTING

Three First Nations communities and one remote mining community in Cape York, Australia.

PARTICIPANTS

In-person semi-structured interviews were conducted with 23 primary healthcare workers; 40% identified as Aboriginal and/or Torres Strait Islander.

RESULTS

The study identified three themes relating to feasibility of implementation: (1) resource coherence and readability, (2) suitability for integration into the care model and (3) safety and risk associated with sick day management plans. Iterative development of resources followed, incorporating feedback from the participants. Recommendations emerged for enhanced readability and coherence, including further co-design with individual communities and consumers, content simplification, incorporation of Aboriginal and/or Torres Strait Islander artwork and language and a flow chart structure.

CONCLUSION

The study underscores the importance of culturally sensitive resource design and the active involvement of Aboriginal and/or Torres Strait Islander communities in healthcare improvement. Future research should explore cost-effective methods for personalised sick day management plans.

Determinants of medication non-adherence among patients with chronic diseases at community pharmacy settings in South Gondar Zone, Northwest Ethiopia: a multicenter cross-sectional study

Background

Medication non-adherence is a significant public health concern in managing patients with chronic diseases, and community pharmacists are on the frontline in the management of chronic medications. Chronic diseases require lifelong pharmacotherapy and understanding the determinants of medication adherence has paramount importance to develop strategies that improve medication adherence and treatment outcomes. Thus, this study aimed to assess the magnitude of medication non-adherence and its contributing factors among patients with chronic diseases attending community pharmacies in South Gondar Zone, Northwest Ethiopia.

Methods

A multicenter cross-sectional study was conducted at community pharmacies in South Gondar Zone from September 01 to October 30, 2023. Medication adherence was assessed using a structured questionnaire using the Adherence in Chronic Diseases Scale (ACDS). Statistical Package for Social Sciences (SPSS) version 25 was used for analysis. Association between the outcome variable and independent variables was performed using binary logistic regression and a p-value of <0.05 was considered statistically significant.

Results

Among three hundred and eighty six (386) study participants recruited in this study, more than half of them 222 (57.51%, 95%CI: 52.4% - 62.5%) were low adherent to their medications. Concerning determinants of medication non-adherence; the presence of side effects (AOR =2.1, 95%CI=1.33-3.29), unable to get ever counseling from community pharmacists (AOR=2.3, 95%CI= 1.46-3.58), and poor about their medications (AOR=3.1, 95% CI= 1.96-4.82) were significantly associated with patients' non-adherence to medications.

Conclusion

The medication adherence level in this study was suboptimal, with a significant proportion of the patients being non-adherent to their medications. The presence of side effects, unable to get ever counseling, and poor knowledge about their medications were statistically significant factors of poorer medication adherence. Hence, healthcare professionals, especially community pharmacists, have a crucial role in designing the schedule for health education concerning the needs of these patients in community pharmacy settings.

The effect of pharmacist-led medication therapy management in the multidisciplinary care of acute kidney injury survivors

BACKGROUND

The Acute Disease Quality Initiative advocates multidisciplinary care for the survivors of acute kidney injury (AKI). The bundled care strategy recognizes the role of pharmacists. However, their specific contributions in this context remain underexplored.

METHODS

This retrospective study examined the efficacy of pharmacist-led post-AKI pharmaceutical care in outpatient settings at a single center. Adults with recent AKI during hospitalization, maintaining an estimated glomerular filtration rate <45 mL/min/1.73 m2 postdischarge, were enrolled in a multidisciplinary team care program from March 2022 to January 2023, with a 6-month follow-up period. Pharmacist-delivered care adhered to international multidisciplinary consensus guidelines. Efficacy was evaluated by analyzing medication-related recommendations, medication adherence, nephrotoxic drug utilization, and renoprotective medication usage before and after the intervention.

RESULTS

A total of 40 patients were referred to the pharmacist-managed clinic. Of these, 33 patients (mean age, 63 ± 15 years; 60.6% male) attended the clinic. Nineteen patients completed follow-up visits. The pharmacist provided 14 medication-related recommendations to relevant physicians, with 10 of these recommendations (71.4%) being accepted. There was a significant decrease in the use of modifiable nephrotoxic drugs (p = 0.03). However, no significant improvements were noted in medication adherence or the utilization of renoprotective medications.

CONCLUSION

Our study underscores the potential benefits of pharmacist-led post-AKI bundled care strategy in outpatient settings. We observed a significant reduction in the utilization of modifiable nephrotoxic drugs, indicating the effectiveness of pharmacist interventions in optimizing medication regimens to mitigate renal harm.

Structural Equation Modelling to Identify Psychometric Determinants of Medication Adherence in a Survey of Kidney Dialysis Patients

Purpose

Medication non-adherence in dialysis patients is associated with increased mortality and higher healthcare costs. We assessed whether medication adherence is influenced by specific psychometric constructs measuring beliefs about the necessity for medication and concerns about them. We also tested whether medication knowledge, health literacy, and illness perceptions influenced this relationship.

Patients and Methods

This study is based on data from a cross-sectional in-person questionnaire, administered to a random sample of all adult dialysis patients at a teaching hospital. The main outcome was self-assessed medication adherence (8-Item Morisky Medication Adherence Scale). The predictors were: concerns about medications and necessity for medication (Beliefs About Medication Questionnaire); health literacy; medication knowledge (Medication Knowledge Evaluation Tool); cognitive, emotional, and comprehensibility Illness perceptions (Brief Illness Perception Questionnaire). Path analysis was performed using structural equations in both covariance and variance-based models.

Results

Necessity for medication increased (standardized path coefficient [β] 0.30 [95% CI 0.05, 0.54]) and concerns about medication decreased (standardized β -0.33 [-0.57, -0.09]) medication adherence, explaining most of the variance in outcome (r2=0.95). Medication knowledge and cognitive illness perceptions had no effects on medication adherence, either directly or indirectly. Higher health literacy, greater illness comprehension, and a more positive emotional view of their illness had medium-to-large sized effects in increasing medication adherence. These were indirect rather and direct effects mediated by decreases in concerns about medications (standardized β respectively -0.40 [-0.63,-0.16], -0.60 [-0.85, -0.34], -0.33 [-0.52, -0.13]).

Conclusion

Interventions that reduce patients' concerns about their medications are likely to improve adherence, rather than interventions that increase patients' perceived necessity for medication. Improving patients' general health literacy and facilitating a better understanding and more positive perception of the illness can probably achieve this. Our study is potentially limited by a lack of generalizability outside of the population and setting in which it was conducted.

Sex disparities in mortality and cardiovascular outcomes in chronic kidney disease

Sex (biologically determined) and gender (socially constructed) modulate manifestations and prognosis of a vast number of diseases, including cardiovascular disease (CVD) and chronic kidney disease (CKD). CVD remains the leading cause of death in CKD patients. Population-based studies indicate that women present a higher prevalence of CKD and experience less CVD than men in all CKD stages, although this is not as clear in patients on dialysis or transplantation. When compared to the general population of the same sex, CKD has a more negative impact on women on kidney replacement therapy. European women on dialysis or recipients of kidney transplants have life expectancy up to 44.8 and 19.8 years lower, respectively, than their counterparts of similar age in the general population. For men, these figures stand at 37.1 and 16.5 years, representing a 21% to 20% difference, respectively. Hormonal, genetic, societal, and cultural influences may contribute to these sex-based disparities. To gain a more comprehensive understanding of these differences and their implications for patient care, well-designed clinical trials that involve a larger representation of women and focus on sex-related variables are urgently needed. This narrative review emphasizes the importance of acknowledging the epidemiology and prognosis of sex disparities in CVD among CKD patients. Such insights can guide research into the underlying pathophysiological mechanisms, leading to optimized treatment strategies and ultimately, improved clinical outcomes.

Patient activation in advanced chronic kidney disease: a cross-sectional study

BACKGROUND

Patient activation refers to the knowledge, confidence and skills required for the management of chronic disease and is antecedent to self-management. Greater self-management in chronic kidney disease (CKD) results in improved patient experience and patient outcomes.

AIM

To examine patient activation levels in people with CKD stage 5 pre-dialysis and determine associations with sociodemographic characteristics, treatment adherence and healthcare utilisation.

METHODS/DESIGN

People with CKD stage 5 not receiving dialysis from one Australian kidney care service. Patient activation was measured using the 13-item Patient Activation Measure (PAM-13). Sociodemographic and clinical outcome data (emergency department visits, admissions) were collected from medical records. Morisky Medication Adherence Scale was used to determine self-report medication adherence.

RESULTS

Two hundred and four participants completed the study. The mean PAM-13 score was 53.4 (SD 13.8), with 73% reporting low activation levels (1 and 2). Patient activation scores significantly decreased with increased age (P < 0.001) and significantly increased with higher educational levels (P < 0.001). Higher patient activation level was associated with fewer hospital emergency department visits (P = 0.03) and increased medication adherence (P < 0.001).

CONCLUSION

Patient activation levels are low in people with CKD stage 5 not receiving dialysis suggesting limited ability for self-management and capacity for optimally informed decisions about their healthcare. Efforts to improve patient activation need to consider age and education level.

Randomised, blinded, cross-over evaluation of the palatability of and preference for different potassium binders in participants with chronic hyperkalaemia in the USA, Canada and Europe: the APPETIZE study

OBJECTIVES

Traditional potassium (K+) binders for treating hyperkalaemia are unpalatable and poorly tolerated. Newer K+ binders are reportedly better tolerated; however, no published data describe their palatability, a determinant of long-term adherence. This study evaluated the palatability of and preference for three K+ binders: sodium and calcium polystyrene sulfonate (S/CPS), sodium zirconium cyclosilicate (SZC) and calcium patiromer sorbitex (patiromer).

DESIGN

Phase 4, randomised, participant-blinded, cross-over study. Participants were randomised to one of six taste sequences and, using a 'sip and spit' approach, tasted each K+ binder before completing a survey.

SETTING

17 centres across the USA, Canada and European Union.

PARTICIPANTS

144 participants with chronic kidney disease, hyperkalaemia and no recent use of K+ binders.

MAIN OUTCOME MEASURES

For the primary (USA) and key secondary (Canada and European Union) endpoints, participants rated palatability attributes (taste, texture, smell and mouthfeel) and willingness to take each K+ binder on a scale of 0-10 (rational evaluation). Feelings about each attribute, and the idea of taking the product once daily, were evaluated using a non-verbal, visual measure of emotional response. Finally, participants ranked the K+ binders according to palatability.

RESULTS

In each region, SZC and patiromer outperformed S/CPS on overall palatability (a composite of taste, texture, smell and mouthfeel), based on rational evaluation and emotional response. Taking the product once daily was more appealing for SZC and patiromer, creating greater receptivity than the idea of taking S/CPS. The emotional response to mouthfeel had the strongest influence on feelings about taking each product. In each region, a numerically greater proportion of participants ranked SZC as the most preferred K+ binder versus patiromer or S/CPS.

CONCLUSIONS

Preference for more palatable K+ binders such as SZC and patiromer may provide an opportunity to improve adherence to long-term treatment of hyperkalaemia.

TRIAL REGISTRATION NUMBER

NCT04566653.

Exploring patient delay in people with chronic kidney disease: A cross-sectional study

To examine the factors that contribute to patient delays among individuals with chronic kidney disease (CKD) and offer insights to help develop specific risk management strategies. Conducted as a cross-sectional study between September 2021 and April 2022, this study used a convenient sampling technique to select 245 individuals diagnosed with CKD from a Grade 3 Class A hospital located in Shanxi Province. These individuals were chosen as the subjects of the study. The research participants underwent an investigation using several assessment tools, including socio-demographic information questionnaire, medical behavior, the social support rating scale, the simplified coping style questionnaire, and the General Self-efficacy Scale. The study revealed that 35.4% of individuals with CKD experienced patient delay (the interval between the initial onset and the time of seeking medical attention being longer than or equal to 3 months). Through a multifactorial logistic regression analysis, it was determined that various factors independently influenced patient delay in patients with CKD. These factors included the level of knowledge about CKD, educational level, frequency of attending physical examinations, severity of initial symptoms, social support, self-efficacy, positive coping, and negative coping. Numerous factors contribute to the Patient Delay. To effectively enhance awareness and coping abilities regarding CKD in high-risk groups, it is essential to implement focused and continuous interventions throughout the medical seeking process.

The Effects of Pharmacist-Led Medication Therapy Management on Medication Adherence and Use of Non-Steroidal Anti-Inflammatory Drug in Patients with Pre-End Stage Renal Disease

Purpose

Patients with chronic kidney disease (CKD) are particularly vulnerable to the risks of polypharmacy, largely owing to various comorbid conditions. This vulnerability is further compounded by an escalated risk of renal function deterioration when exposed to nephrotoxic medications. As part of the national health insurance program in Taiwan, the pre-end-stage kidney disease patient care and education plan has included pharmaceutical care since October 2021. This study aims to explore the effect of pharmacist involvement in a multidisciplinary care team for patients with kidney disease in outpatient settings.

Patients and Methods

This retrospective observational study was conducted at a single center. It analyzed data from May 2022 to May 2023, focusing on patients who received medication therapy management in the kidney disease pharmacist-managed clinic. The study assessed changes in patient medication adherence, non-steroidal anti-inflammatory drugs (NSAIDs) usage, CKD stage, and urine protein-to-creatinine ratio (UPCR) after pharmacist intervention. It also documented pharmacists' medication recommendations and the rate of acceptance by physicians.

Results

A total of 202 patients who had at least two clinic visits were included in the study. After pharmacist intervention, the proportion of poor medication adherence reduced significantly from 67.8% to 43.1% (p<0.001). The proportion of NSAID users also decreased significantly from 19.8% to 8.4% (p=0.001). CKD stage showed a significant reduction (p=0.007), and the average UPCR improved from 2828.4 to 2111.0 mg/g (p<0.001). The pharmacists provided a total of 56 medication recommendations, with an acceptance rate of 86%.

Conclusion

The involvement of pharmacists in the multidisciplinary care team can effectively provide medication-related recommendations, ensuring the effectiveness and safety of patients' medication use, and lead to better kidney function and lower proteinuria.

Medication Adherence Among Patients With Kidney Disease: An Umbrella Review

Chronic kidney disease (CKD) imposes a significant medication burden on patients due to the necessity of multiple treatments to slow disease progression, manage coexisting conditions, and address complications. The complex medication regimen, in turn, has implications for clinical and patient-centered outcomes. This umbrella review provides comprehensive evidence on extent of medication nonadherence among adults with CKD, as well as associated risk factors, outcomes, and the effectiveness of interventions by synthesizing evidence from published systematic reviews and/or meta-analyses. We identified 37 works that met our inclusion criteria. These reviews covered various aspects of treatment adherence in people with CKD, which can be categorized into four main themes: (i) prevalence of treatment nonadherence; (ii) factors associated with (non)adherent behaviors; (iii) outcomes associated with treatment (non)adherence; and (iv) interventions to improve treatment adherence or overall self-management practices. Approximately half of the included studies (15/34) focused on interventions aimed at improving medication adherence or overall CKD management, while outcomes associated with medication (non)adherence were relatively underexplored in the literature. The reported prevalence rates of medication nonadherence varied widely among reviews and stages of CKD. The determinants of adherence identified included socioeconomic variables, disease or clinical conditions, and psychosocial factors. Common interventions to improve adherence included nurse-led interventions, pharmaceutical services, and eHealth technologies, which had varying effects on medication adherence or dialysis sessions.

Hypertension doctors' awareness and practice of medication adherence in hypertensive patients: a questionnaire-based survey

Background

Poor adherence to antihypertensive drugs is a major cause of unsatisfactory blood pressure control. Hypertension doctors play an integral role in improving medication adherence in hypertensive patients. Although most existing studies have recognized the status quo and influencing factors of medication adherence, little attention has been paid to hypertension doctors' awareness and practice in hypertension management. Therefore, in this study, we aimed to investigate hypertension doctors' awareness and practice of medication adherence in hypertensive patients.

Methods

This is a cross-sectional survey. A self-reported questionnaire was developed and sent to hypertension doctors in Hunan province, China, between May 1, 2022 and July 1, 2022. Univariate and generalized linear models were used to identify the factors influencing hypertension doctors' awareness and practice. The correlation between awareness and practice was determined using Spearman's correlation coefficient.

Results

In total, 236 valid questionnaires were collected (valid response rate, 73.5%). Of the respondents, 44.1% were chief physicians and 64.4% were females. Approximately half of the respondents were ≥40 years old and had over 14 years of working experience. Most respondents (87.7%) did not have hypertension, but 54.2% had a family history of hypertension. The average awareness and practice scores were 29.8 ± 8.8 and 39.4 ± 7.1, respectively, out of 50, with higher scores indicating higher levels of awareness or practice. More hypertension consultations and more antihypertensive prescriptions issued were associated with better awareness and practice among respondents (ps < 0.05). Respondents with higher education and professional titles had higher awareness (ps < 0.05). Moreover, respondents with 6-13 years of work experience had better practice than those with <5 years of work experience (p = 0.017). There was a significant correlation between hypertension doctors' awareness and practice of medication adherence in hypertensive patients (R = 0.682, p < 0.001). These findings indicate that misconceptions persist in hypertension doctors' awareness and practice of patient medication adherence.

Conclusion

Hypertension doctors lack sufficient and correct awareness and practice of medication adherence in hypertensive patients.

Impact of ACEIs and ARBs-related adverse drug reaction on patients' clinical outcomes: a cohort study in UK primary care

BACKGROUND

Adverse drug reaction (ADR) related to angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) may negatively affect patients' treatment outcomes.

AIM

To investigate the impact of ACEIs/ARBs-related ADR consultation on cardiovascular disease (CVD) events and all-cause mortality.

DESIGN AND SETTING

Propensity score-matched cohort study of ACEIs/ARBs between 2004 and 2019 using UK IQVIA medical research data.

METHOD

ADR consultations were identified using standardised designated codes. Propensity scores were calculated based on comorbidities, concomitant medications, frailty, and polypharmacy. Cox's proportional hazard regression model was used to compare the outcomes between patients in ADR and non-ADR groups. In the secondary analysis, treatment- pattern changes following the ADR were examined and the subsequent outcomes were compared.

RESULTS

Among 1 471 906 eligible users of ACEIs/ARBs, 13 652 (0.93%) patients had ACEIs/ARBs- related ADR consultation in primary care. Patients with ACEIs/ARBs-related ADR consultation had an increased risk of subsequent CVD events and all- cause mortality in both primary prevention (CVD events: adjusted hazard ratio [aHR] 1.22, 95% confidence interval [CI] = 1.05 to 1.43; all-cause mortality: aHR 1.14, 95% CI = 1.01 to 1.27) and secondary prevention cohorts (CVD events: aHR 1.13, 95% CI = 1.05 to 1.21; all-cause mortality: aHR 1.15, 95% CI = 1.09 to 1.21). Half (50.19%) of patients with ADR continued to use ACEIs/ARBs, and these patients had a reduced risk of mortality (aHR 0.88, 95% CI = 0.82 to 0.95) compared with those who discontinued using ACEIs/ARBs.

CONCLUSION

This study provides information on the burden of ADR on patients and the health system. The findings call for additional monitoring and treatment strategies for patients affected by ADR to mitigate the risks of adverse clinical outcomes.

The Interrelations of Family Relationship, Illness Cognition of Helplessness and Perceived Barriers to Medication Adherence: A Study of Adolescent and Emerging Adult Kidney Recipients and Their Parents

Background

Medication adherence among adolescents and emerging adults following kidney transplantation was found to be lower with harmful consequences. The current study aimed to examine associations between illness cognition of helplessness, family relationships, and perceived barriers to medication adherence among post-kidney transplant adolescent and emerging adult recipients and their parents by applying a dyadic perspective.

Methods

Fifty-nine dyads of adolescents and emerging adults aged 11-26 years and their parents, were recruited from a pediatric nephrology department in a medical center in Israel. Both adolescents and emerging adults and parents completed self-report questionnaires addressing illness cognition of helplessness (subscale of Illness Cognition Questionnaire), family relationships related to conflict and cohesion (Brief Family Relationship Scale), and the adolescents' perceived barriers (Adolescent Medication Barriers Scale) to taking their prescribed medications.

Results

Adolescents' and emerging adults' perceptions of family conflicts moderated the link between illness cognition of helplessness among parents and barriers to medication adherence via the illness cognition of helplessness among adolescents and emerging adults. However, only the adolescents' and emerging adults' perceptions of family cohesion had a direct association with barriers to medication adherence. Parents' perceived family conflict and cohesion did not directly associate with barriers to medication adherence. Findings highlight the complex interplay between family dynamics, illness cognition, and barriers to medication adherence in adolescents and emerging adults.

Conclusion

Parents', adolescents' and emerging adults' perceptions of family conflicts and cohesion, as well as their illness cognitions, can play important roles in understanding and addressing barriers to medication adherence in this population. The study reveals findings that highlight the dyadic transference process of illness cognition of helplessness among both adolescent and emerging adult kidney recipients and their parents in assessing barriers to medical treatment.

Medication Bias During the Hospital-to-Family Transition Among Young and Middle-Aged Chinese Patients with Type 2 Diabetes: A Qualitative Study

Objective

This study aimed to examine the prevalence of medication non-adherence among young and middle-aged Chinese individuals diagnosed with type 2 diabetes, and to explore the underlying causes of such deviations.

Methods

The Medication Discrepancy Tool (MDT) was used to assess medication deviations in a cohort of 100 patients who had been discharged from the hospital. Furthermore, 15 subjects were interviewed to gain a better understanding of their medication non-adherence experiences.

Results

The rate of medication deviation in the studied cohort was 79.5%, with the most frequent deviation being a reduction in the types of drugs taken. The primary cause of this deviation was found to be patient-derived, with the most common reason being symptom improvement. Iatrogenic medication deviation was most often caused by incomplete or inaccurate medication education for medical staff at discharge, resulting in patients having to guess their own medication. Internal and extrinsic motivating factors were identified as the primary causes of medication deviation behavior.

Conclusion

This study has demonstrated that medication non-adherence is a major issue among young and middle-aged Chinese individuals diagnosed with type 2 diabetes. Therefore, it is essential for nurses to be aware of the importance of medication adherence management and working.

Depression among patients with chronic kidney disease, associated factors, and predictors: a cross-sectional study

BACKGROUND

Depression with diverse etiologies is exacerbated by chronic diseases, such as chronic kidney disease (CKD), coronary artery disease (CAD), cancer, diabetes mellitus, and hypertension. This study aimed to analyse depression, its associations, and predictors among patients attending the kidney clinic of a teaching hospital.

METHODS

Data were collected from 01 August 2017 to 30 September 2017 via face-to-face interviews and examination of the medical records of a convenience sample of 314 patients. The patients were categorised broadly as stages I and II with an estimated glomerular filtration rate (eGFR) > 60 mls/min/1.73 m2, and with stages III, IV, and V or GFR ≤ 60 mls/ min/1.73 m2 (or CKD). The Patient Health Questionnaire (PHQ)-9 was the data collection instrument for depression-related data.

RESULTS

Participants were predominantly male (n = 179; 57.0%), aged over 60 years (n = 211; 67.2%), Indo-Trinbagonian (n = 237; 75.5%), and with stages III, IV, and V CKD. The two leading comorbid conditions were hypertension (83.4%) and diabetes mellitus (56.1%). Of the 261 (83.1%) patients with recorded eGFR, 113 (43.3%) had Stage III CKD. The mean depression (PHQ-9) score was 13.0/27 (±9.15), with 306 (97.5%) patients diagnosed as having depression with the following severities: mild (n = 116; 37.9%), moderate (n = 138, 45.1%), moderately severe (n = 38; 12.4%), and severe (n = 14; 4.6%). Depression was independent of sex. Nine sociodemographic variables were associated with depression; however, 'level of education', was the only predictor of depression with greater severity associated with lower levels of education. eGFR was negatively correlated with the PHQ-9 scores (Pearson's correlation, r = -0.144, p = 0.022). At least 78.3% of the patients who self-reported no depression had clinical depression (moderate, moderately severe, or severe) PHQ-9 scores ≥ 10.

CONCLUSION

Depression was a significant comorbidity among patients with CKD, with the majority displaying clinical depression. "Level of education" was the only predictor of depression. Self-reported depression is an unreliable method for evaluating clinical depression.

The Effect of Health Literacy on Patient Outcomes in Stage 3b-4 Pre-Dialysis Patients: A Semi-Experimental Study

This study was conducted to investigate the effect of health literacy on patient outcomes in pre-dialysis patients. A semi-experimental study. The study was conducted with 45 intervention and 45 control patients with glomerular filtration rates between 15-44ml/min/1.73m2. The adequate health literacy of the patients in the intervention group increased from 2.2% to 31.1%. Increased health literacy led to a significant decrease in systolic and diastolic blood pressure values and the severity of symptoms. The study showed that increased health literacy in pre-dialysis patients improves patient outcomes. Nursing care is needed in pre-dialysis.

Psychological Distress and Self-Management in CKD: A Cross-Sectional Study

Rationale & Objective

Patients with chronic kidney disease (CKD) not receiving dialysis, including kidney transplant recipients, often experience difficulties regarding self-management. An important barrier for adherence to self-management recommendations may be the presence of psychological distress, consisting of depressive and anxiety symptoms. We investigated relationships between psychological distress and adherence to self-management recommendations.

Study Design

Cross-sectional online questionnaire data as part of the E-GOAL study.

Setting & Participants

Patients with CKD (estimated glomerular filtration rate, 20-89 mL/min/1.73 m2) were recruited from April 2018 to October 2020 at 4 hospitals in The Netherlands and completed online screening questionnaires.

Exposures

Psychological distress, depressive symptoms, and anxiety symptoms.

Outcomes

Dietary adherence, physical activity, medication adherence, smoking, body mass index, and a CKD self-management index (ie, the sum of 5 binary indicators of nonadherence to the recommended self-management factors).

Analytical Approach

Adjusted multivariable regression and ordinal logistic regression analyses.

Results

In our sample (N = 460), 27.2% of patients reported psychological distress, and 69.8% were nonadherent to 1 or more recommendations. Higher psychological distress was significantly associated with poorer dietary adherence (βadj, -0.13; 95% CI, -0.23 to -0.04), less physical activity (βadj, -0.13; 95% CI, -0.22 to -0.03), and lower medication adherence (βadj, -0.15; 95% CI, -0.24 to -0.05), but not with smoking and body mass index. Findings were similar for depressive symptoms, whereas anxiety was only associated with poorer dietary and medication adherence. Every 1-point higher psychological distress was also associated with a higher likelihood of being nonadherent to an accumulating number of different recommendations (adjusted OR, 1.04; 95% CI, 1.02-1.07).

Limitations

Cross-sectional design, possible residual confounding, and self-report.

Conclusions

Many people with CKD experience psychological distress, of whom most have difficulties self-managing their CKD. Given the relationship between psychological distress and adherence to CKD self-management recommendations, behavioral interventions are needed to identify and treat psychological distress as a potential barrier to CKD self-management.

Plain-Language Summary

This online questionnaire study investigated relationships between psychological distress and self-management among 460 people with chronic kidney disease. Over a quarter of them reported mild-to-severe psychological distress. Alarmingly, 4 out of 5 patients with psychological distress were also nonadherent to 1 or more self-management recommendations, and higher levels of psychological distress were associated with poorer dietary and medication adherence and lower physical activity. Moreover, patients who suffered from moderate-to-severe distress were relatively more often nonadherent to 3 or more recommendations compared with patients with no or mild distress symptoms. So, it seems that psychological distress can be a barrier for self-management. To support patients in managing chronic kidney disease, researchers and health professionals should not overlook patients' mental health.

Prevalence and Modifiable Factors for Holistic Non-Adherence in Renal Transplant Patients: A Cross-Sectional Study

Introduction

In renal transplant recipients, compliance with medical therapy is vital. Non-adherence is considered a risk factor for worst outcomes in kidney recipients, with attributed outcomes of 64% for graft loss and 80% for late acute rejection. Most literature defines adherence as self-based immunosuppression compliance but does not consider other relevant factors such as consult and procedure compliance. Therefore, this study aims to describe adherence prevalence in kidney transplant recipients and the factors related to non-adherence.

Methods

This cross-sectional study included 1030 renal transplant patients followed by Colombiana de Trasplantes between January 2019 and July 2021. Sociodemographic and clinical variables were obtained based on clinical records. The mental-health group diagnosed holistic adherence in a semi-structured interview. The diagnosis considered medication intake failure, frequency and number of failures to medical controls or other procedures, suspicious non-adherence behaviors, and serum levels of immunosuppressants. A bivariate followed a descriptive analysis, and a forward logistic regression was performed for non-adherence.

Results

Patients had a median of 47 years, and 58.1% were male. Non-adherence was presented in 30.7% of patients. The non-adherence patients were younger, with a higher prevalence of males, single, divided transplant care, had a longer time after transplantation, psychopathological diagnosis, and more reinforcement education by only nursing. Older age and multidisciplinary reinforcement education were protective factors. On the other hand, poor social support, psychopathology diagnosis, and longer time after transplant presented as non-adherence risk factors.

Conclusion

Holistic non-adherence was diagnosed in approximately one-third of renal transplant recipients. Its definition included more than just medication non-compliance and could identify more non-adherent patients. Notably, there is a need to consider the related factors in the health follow-up and encourage future research in modifiable factor interventions aiming to increase adherence and achieve better outcomes for renal transplant patients.

Development and validation of a nomogram model for medication non-adherence in patients with chronic kidney disease

OBJECTIVE

The high prevalence of medication non-adherence in patients with chronic kidney disease places a tremendous burden on healthcare resources. The study was designed to develop and validate a nomogram model of medication non-adherence in patients with chronic kidney disease in China.

METHODS

A multicenter cross-sectional study was conducted. 1206 chronic kidney disease patients were consecutively enrolled from Be Resilient to Chronic Kidney Disease (registration number: ChiCTR2200062288) between September 2021 and October 2022 in four tertiary hospitals in China. The Chinese version of four-item Morisky Medication Adherence Scale was used to assess the medication adherence of the patients and associated factors consisted of socio-demographic information, self-designed medication knowledge questionnaire, the 10-item Connor-Davidson Resilience Scale, the Beliefs about Medicine questionnaire, the Acceptance Illness Scale, and the Family Adaptation Partnership Growth and Resolve Index. Least Absolute Shrinkage and Selection Operator regression was performed to select significant factors. Concordance index, Hosmer-Lemeshow test and decision curve analysis were estimated.

RESULTS

The prevalence of medication non-adherence was 63.8%. Area under the curves ranged from 0.72 to 0.96 in internal and external validation sets. The predicted probabilities of the model were consistent with those of the actual observations by Hosmer-Lemeshow test (all P > .05). The final model included educational level, occupational status, duration of chronic kidney disease, medication beliefs (perceptions of the need to take medications and concerns about adverse effects), and illness acceptance (adaptation and acceptance of the disease).

CONCLUSIONS

There is a high prevalence of medication non-adherence among Chinese patients with chronic kidney disease. A nomogram model based on five factors has been successfully developed and validated and could be incorporated into long-term medication management.

Insights Into Medication Adherence Among Patients With Chronic Diseases in Jeddah, Saudi Arabia: A Cross-Sectional Study

Background Non-adherence to medication is a common problem in managing chronic diseases, which are a significant public health concern globally. This study aimed to identify factors related to medication adherence among patients with chronic diseases in Saudi Arabia. Methods A cross-sectional survey design was used to collect data through an online survey administered to 400 patients with chronic diseases residing in Jeddah between January and March 2023. The survey included questions about socio-demographic characteristics, chronic disease diagnosis, medication adherence, and factors that may influence medication adherence. Results This study recruited 400 participants and found that the majority were female, with a mean age of 46.2 years, and most had at least one chronic disease, with hypertension and diabetes being the most common. The medication adherence score for the entire sample was 5.4, indicating moderate adherence. Overall, 22.9% of study participants had poor adherence to medications. Factors associated with medication adherence included age, gender, and education level, with older age, female gender, and higher education being positively associated with adherence. Medication-related factors such as the number of medications prescribed, medication complexity, and medication cost were also found to be significantly associated with medication adherence. Conclusion Our study of medication adherence among chronic disease patients in Saudi Arabia found that adherence rates were moderate, with several factors significantly associated with better adherence. Specifically, older age, female gender, and higher education level were positively associated with better adherence, while a higher number of prescribed medications, more complex medication regimens, and higher medication costs were all significant predictors of poorer adherence.

Older Individuals' Experiences of Medication Management and Care After Discharge from Hospital: An Interview Study

PURPOSE

To develop an in-depth understanding of older individuals' attitudes and perceptions of medication management and care after discharge from hospital-to-home.

PATIENTS AND METHODS

A qualitative study using semi-structured interviews with selected individuals 75 years and older, discharged from hospital within the last 6-12 months, living at home, and managing their own medications. Face-to-face interviews were audio-recorded, transcribed and analyzed with thematic analysis.

RESULTS

Among the 15 respondents, mean age was 83.5 years (range 75-95 years), 67% were women, and 60% lived alone. The majority (80%) managed their medications with a pill organizer or directly from the pill boxes, while 20% used dose dispensed medications. The analysis of the data led to six themes: Medication adherence, Personal responsibility, Transitions of care, Beliefs about medications, Participation (experience of participation, willingness to participate) and Accessibility (easier to reach hospital than primary care, navigating in the care system, continuity, personal chemistry).

CONCLUSION

The included respondents who were older individuals, living at home and managing their own medications, expressed that they were medical adherent and self-managing. Two important aspects which were seen were difficulties to reach primary care on their own initiative and the lack of continuity with the same physician over a longer period of time.

eHealth to Improve Psychological Functioning and Self-Management of People With Chronic Kidney Disease: A Randomized Controlled Trial

OBJECTIVE

Psychological distress is common among patients with chronic kidney disease and can interfere with disease self-management. We assessed the effectiveness of the personalized E-GOAL electronic health care pathway with screening and cognitive-behavioral therapy including self-management support, aimed to treat psychological distress and facilitate self-management among people with chronic kidney disease not on dialysis ( N = 121).

METHODS

Primary outcome of the open two-arm parallel randomized controlled trial in four Dutch hospitals was psychological distress at posttest directly after the intervention and at 3-month follow-up. Secondary outcomes were physical and mental health-related quality of life, self-efficacy, chronic disease self-management, and personalized outcomes, that is, perceived progress compared with the previous time point on functioning (e.g., mood or social functioning) and self-management (e.g., dietary or medication adherence) outcomes that were prioritized by each individual.

RESULTS

Linear mixed-effects analyses showed no significant time-by-group interaction effects for psychological distress, health-related quality of life, self-efficacy, and chronic condition self-management, whereas analyses of covariance showed significantly more perceived progress in the intervention group at posttest on personally prioritized areas of functioning ( b = 0.46, 95% confidence interval = 0.07-0.85) and self-management ( b = 0.55, 95% confidence interval = 0.16-0.95), with Cohen d values of 0.46 and 0.54 (medium effects), respectively. Effects on personalized outcomes were maintained at follow-up.

CONCLUSIONS

Compared with regular care only, the electronic health intervention did not reduce psychological distress, whereas personalized outcomes did improve significantly after intervention. Future studies could consider personalized outcomes that reflect individually relevant areas and treatment goals, matching person-tailored treatments.

TRIAL REGISTRATION

Registered at the Netherlands Trial Register with study number NTR7555 ( https://trialsearch.who.int/Trial2.aspx?TrialID=NTR7555 ).

SPUR: A Patient-Reported Medication Adherence Model as a Predictor of Admission and Early Readmission in Patients Living with Type 2 Diabetes

PURPOSE

Poor medication adherence (MA) is linked to an increased likelihood of hospital admission. Early interventions to address MA may reduce this risk and associated health-care costs. This study aimed to evaluate a holistic Patient Reported Outcome Measure (PROM) of MA, known as SPUR, as a predictor of general admission and early readmission in patients living with Type 2 Diabetes.

PATIENTS AND METHODS

An observational study design was used to assess data collected over a 12-month period including 6-month retrospective and 6-month prospective monitoring of the number of admissions and early readmissions (admissions occurring within 30 days of discharge) across the cohort. Patients (n = 200) were recruited from a large South London NHS Trust. Covariates of interest included: age, ethnicity, gender, level of education, income, the number of medicines and medical conditions, and a Covid-19 diagnosis. A Poisson or negative binomial model was employed for count outcomes, with the exponentiated coefficient indicating incident ratios (IR) [95% CI]. For binary outcomes (Coefficient, [95% CI]), a logistic regression model was developed.

RESULTS

Higher SPUR scores (increased adherence) were significantly associated with a lower number of admissions (IR = 0.98, [0.96, 1.00]). The number of medical conditions (IR = 1.07, [1.01, 1.13]), age ≥80 years (IR = 5.18, [1.01, 26.55]), a positive Covid-19 diagnosis during follow-up (IR = 1.83, [1.11, 3.02]) and GCSE education (IR = 2.11, [1.15,3.87]) were factors associated with a greater risk of admission. When modelled as a binary variable, only the SPUR score (-0.051, [-0.094, -0.007]) was significantly predictive of an early readmission, with patients reporting higher SPUR scores being less likely to experience an early readmission.

CONCLUSION

Higher levels of MA, as determined by SPUR, were significantly associated with a lower risk of general admissions and early readmissions among patients living with Type 2 Diabetes.

Digital health technologies to support medication adherence in chronic kidney disease

Non-adherence to medications is a critical challenge in the management of people with chronic kidney disease (CKD). This review explores the complexities of adherence in this population, the unique barriers and enablers of good adherence behaviours, and the role of emerging digital health technologies in bridging the gap between evidence-based treatment plans and the real-world standard of care. We present the current evidence supporting the use of digital health interventions among CKD populations, identifying the key research questions that remain unanswered, and providing practical strategies for clinicians to support medication adherence in a digital age.

Assessment of Health-Related Quality of Life, Medication Adherence, and Prevalence of Depression in Kidney Failure Patients

BACKGROUND

Kidney failure is a global health problem with a worldwide mean prevalence rate of 13.4%. Kidney failure remains symptomless during most of the early stages until symptoms appear in the advanced stages. Kidney failure is associated with a decrease in health-related quality of life (HRQOL), deterioration in physical and mental health, and an increased risk of cardiovascular morbidity and mortality. This study aimed to evaluate the factors associated with decreased HRQOL and other factors affecting the overall health of patients. Another objective was to measure how medication adherence and depression could affect the overall HRQOL in patients with kidney failure.

METHODOLOGY

The study used a prospective follow-up mix methodology approach with six-month follow-ups of patients. The participants included in the study population were those with chronic kidney disease grade 4 and kidney failure. Pre-validated and translated questionnaires (Kidney Disease Quality of Life-Short Form, Hamilton Depression Rating Scale Urdu Version, and Morisky Lewis Greens Adherence Scale) and assessment tools were used to collect data.

RESULTS

This study recruited 314 patients after an initial assessment based on inclusion criteria. The mean age of the study population was 54.64 ± 15.33 years. There was a 47.6% male and a 52.4% female population. Hypertension and diabetes mellitus remained the most predominant comorbid condition, affecting 64.2% and 74.6% of the population, respectively. The study suggested a significant (p < 0.05) deterioration in the mental health composite score with worsening laboratory variables, particularly hematological and iron studies. Demographic variables significantly impact medication adherence. HRQOL was found to be deteriorating with a significant impact on mental health compared to physical health.

CONCLUSIONS

Patients on maintenance dialysis for kidney failure have a significant burden of physical and mental symptoms, depression, and low HRQOL. Given the substantial and well-known declines in physical and psychological well-being among kidney failure patients receiving hemodialysis, the findings of this research imply that these areas related to health should receive special attention in the growing and expanding population of kidney failure patients.

Treatment Adherence in CKD and Support From Health care Providers: A Qualitative Study

Rationale & Objective

Adherence to recommended medical treatment is critical in chronic kidney disease (CKD) to prevent complications and progression to kidney failure. Overall adherence to treatment is low in CKD, and as few as 40% of patients with kidney failure receive any documented CKD-related care. The purpose of this study was to explore the experiences of patients with CKD and their adherence to CKD treatment plans, and the role their health care providers played in supporting their adherence.

Study Design

One-on-one interviews were conducted in 2019-2020 using a semi-structured interview guide. Participants described experiences with adherence to treatment plans and what they did when experiencing difficulty.

Setting & Participants

Participants were recruited from the Chronic Renal Insufficiency Cohort (CRIC) study. All CRIC participants were older than 21 years with CKD stages 2-4; this sample consisted of participants from the University of Pennsylvania CRIC site.

Analytical Approach

Interviews were recorded, transcribed, and coded using conventional content analysis. Data were organized into themes using NVivo 12.

Results

The sample (n = 32) had a mean age of 67 years, 53% were women, 59% were non-White, with a mean estimated glomerular filtration rate of 56.6 mL/min/1.73 m2. From analysis of factors relevant to treatment planning and adherence, following 4 major themes emerged: patient factors (multiple chronic conditions, motivation, outlook), provider factors (attentiveness, availability/accessibility, communication), treatment planning factors (lack of plan, proactive research, provider-focused treatment goals, and shared decision making), and treatment plan responses (disagreeing with treatment, perceived capability deficit, lack of information, and positive feedback).

Limitations

The sample was drawn from the CRIC study, which may not be representative of the general population with CKD.

Conclusions

These themes align with Behavioral Learning Theory, which includes concepts of internal antecedents (patient factors), external antecedents (provider factors), behavior (treatment planning factors), and consequences (treatment plan responses). In particular, the treatment plan responses point to innovative potential intervention approaches to support treatment adherence in CKD.

Pruritus in Chronic Kidney Disease: An Update

Chronic kidney disease-associated pruritus (CKDaP) is an often under-diagnosed and under-recognized condition, despite its considerable prevalence within the chronic kidney disease (CKD) population. Universally accepted guidelines are also lacking. The true prevalence of CKDaP worldwide therefore remains unknown, although its negative impact on mortality and health-related quality of life outcomes is very clear. The pathophysiological mechanisms leading to the onset of CKDaP are only partly understood. CKDaP is currently believed to be caused by a multifactorial process, from local skin changes, metabolic alterations, the development of neuropathy and dysregulation of opioid pathways, and psychological factors. Much work has been carried out towards a more systematic and structured approach to clinical diagnosis. Various tools are now available to assess the severity of CKDaP. Many of these tools require greater validation before they can be incorporated into the guidelines and into routine clinical practice. Further efforts are also needed in order to increase the awareness of clinicians and patients so that they can identify the CKDaP signs and symptoms in a timely manner. Currently established treatment options for CKDaP focus on the prevention of xerosis via topical emollients, the optimization of dialysis management, early referral to kidney transplantation if appropriate, oral antihistamine, and a variety of neuropathic agents. Other novel treatment options include the following: topical analgesics, topical tacrolimus, cannabinoid-containing compounds, antidepressants, oral leukotrienes, opioids, and non-pharmacological alternative therapies (i.e., phototherapy, dietary supplements, acupuncture/acupressure). We provide an updated review on the evidence relating to the epidemiology, the pathophysiology, the clinical assessment and diagnosis, and the management of CKDaP.

Factors Affecting Adherence to Phosphate-binding Medications among Patients with End-stage Kidney Disease in Makkah City

Despite the evidence that the management of hyperphosphatemia depends heavily on adherence to phosphate-binding (PB) medications, many dialysis patients are non-adherent. Therefore, factors associated with non-adherence to PB medications should be identified and eliminated. This study aimed to identify and highlight factors influencing adherence to PB medications among patients with end-stage kidney disease (ESKD). A cross-sectional survey was conducted in the hemodialysis centers of three major governmental hospitals in Makkah City, Saudi Arabia. The World Health Organization's five dimensions of adherence to medication (patient, socioeconomic, condition, therapy, and health system) were used to guide the analysis. A multivariable logistic regression analysis was used to determine factors influencing adherence to PB medications among patients with ESKD. Three hundred and fifty-eight patients submitted completed questionnaires and were included in this study; of them, 87.99% were adherent to PB medications. The factors sex, adherence to dietary restrictions, and duration on dialysis were found to be significantly and positively associated with adherence to PB medications, whereas the factors difficulty to take medications and difficulty to adhere to a large number of tablets had significant and negative associations with adherence to PB medications. Hyperphosphatemia is a cause for concern as it leads to several life-threatening complications. The results of the present study encourage to recruit representative samples and consider more factors, such as patients' attitudes toward medications and provider-level factors, to inform policy and/or programmatic interventions that increase adherence to PB medications among patients with ESKD.

Identifying Patterns of Self-Reported Nonadherence Using Network Analysis in a Mixed German Cohort

Purpose

Nonadherence is a complex behaviour that contributes to poor health outcomes; therefore, it is necessary to understand its underlying structure. Network analysis is a novel approach to explore the relationship between multiple variables.

Patients and Methods

Patients from four different studies (N = 1.746) using the self-reported Stendal Adherence to Medication Score (SAMS) were pooled. Network analysis using EBICglasso followed by confirmatory factor analysis were performed to understand how different types of nonadherence covered in the SAMS items are related to each other.

Results

Network analysis revealed different categories of nonadherence: lack of knowledge about medication, forgetting to take medication, and intentional modification of medication. The intentional modification can further be sub-categorized into two groups, with one group modifying medication based on changes in health (improvement of health or adverse effects), whereas the second group adjusts medication based on overall medication beliefs and concerns. Adverse effects and taking too many medications were further identified as most influential variables in the network.

Conclusion

The differentiation between modification due to health changes and modification due to overall medication beliefs is crucial for intervention studies. Network analysis is a promising tool for further exploratory studies of adherence.

Real-World Evaluation of Calcimimetics for the Treatment of Secondary Hyperparathyroidism in Chronic Kidney Disease, in an Italian Clinical Setting

This Italian real-world data analysis evaluated the pharmaco-utilization of calcimimetics, cinacalcet or etelcalcetide, and the economic burden of secondary hyperparathyroidism (SHPT) in chronic kidney disease (CKD) patients. From 1 January 2010 to 30 June 2020, adult patients with: (i) ≥1 prescription of etelcalcetide or cinacalcet, (ii) ≥3 hemodialysis/week, and (iii) without parathyroidectomy, were included. Based on the drug firstly prescribed, patients were allocated into etelcalcetide- and cinacalcet-treated cohorts, and the propensity score matching (PSM) methodology was applied to abate potential cohorts’ unbalances. Overall, 1752 cinacalcet- and 527 etelcalcetide-treated patients were enrolled. In cinacalcet- and etelcalcetide-treated patients, respectively, the most frequent comorbidities were hypertension (75.3% and 74.4%), diabetes mellitus (21.0% and 21.3%), and cardiovascular disease (18.1% and 13.3%, p < 0.01). In covariate-balanced cohorts, the treatment adherence and persistence rates were significantly higher in the etelcalcetide-treated (80.1% and 62.7%, respectively) vs. cinacalcet-treated cohort (62.3% and 54.7%, respectively). After PSM, the total costs for the management of cinacalcet- and etelcalcetide-treated patients, respectively, averaged EUR 23,480 and EUR 22,958, with the disease-specific drug costs (EUR 2629 vs. EUR 2355, p < 0.05) and disease-specific hospitalization costs (EUR 1241 vs. EUR 855) in cinacalcet- and etelcalcetide-treated patients. These results showed that, in etelcalcetide-treated patients, a higher treatment adherence and persistence was found, with disease-specific costs savings, especially those related to drugs and hospitalizations.

Adverse Drug Reactions of Antihypertensives and CYP3A5*3 Polymorphism Among Chronic Kidney Disease Patients

Chronic kidney disease (CKD) patients may be more susceptible to adverse drug reactions (ADRs), given their complex medication regimen and altered physiological state driven by a decline in kidney function. This study aimed to describe the relationship between CYP3A5*3 polymorphism and the ADR of antihypertensive drugs in CKD patients. This retrospective, multi-center, observational cohort study was performed among adult CKD patients with a follow-up period of up to 3 years. ADRs were detected through medical records. CYP3A5*3 genotyping was performed using the direct sequencing method. From the 200 patients recruited in this study, 33 (16.5%) were found to have ADRs related to antihypertensive drugs, with 40 ADRs reported. The most frequent ADR recorded was hyperkalemia (n = 8, 20.0%), followed by bradycardia, hypotension, and dizziness, with 6 cases (15.0%) each. The most common suspected agents were angiotensin II receptor blockers (n = 11, 27.5%), followed by angiotensin-converting enzyme inhibitors (n = 9, 22.5%). The CYP3A5*3 polymorphism was not found to be associated with antihypertensive-related ADR across the genetic models tested, despite adjustment for other possible factors through multiple logistic regression (p > 0.05). After adjusting for possible confounding factors, the factors associated with antihypertensive-related ADR were anemia (adjusted odds ratio [aOR] 5.438, 95% confidence interval [CI]: 2.002, 14.288) and poor medication adherence (aOR 3.512, 95% CI: 1.470, 8.388). In conclusion, the CYP3A5*3 polymorphism was not found to be associated with ADRs related to antihypertensives in CKD patients, which requires further verification by larger studies.

Sex, Gender, and Cardiovascular Disease in Chronic Kidney Disease

This review on sex, gender, and cardiovascular diseases in chronic kidney disease attempts to summarize what we know and what we do not know about the effects of sex and gender on cardiovascular disease in chronic kidney disease. We discuss and define the terminology of sex and gender, and the underlying physiology for differences observed. We explore how sex and gender affect specific cardiovascular diseases such as coronary artery disease, congestive heart failure, arrhythmias, cardiovascular mortality, and pre-eclampsia. We conclude with a review of recent randomized controlled trials and highlight the pharmacokinetic and pharmacodynamic differences in both sexes.

Medication Adherence, Complementary Medicine Usage and Progression of Diabetic Chronic Kidney Disease in Thais

PURPOSE

Non-adherence to medication is receiving more attention as a significant problem common to management of chronic diseases including diabetes and chronic kidney disease (CKD). This study was designed to assess the medication adherence and self-medication in a cohort of Thai patients with diabetic kidney disease, and its association with clinical outcomes.

PATIENTS AND METHODS

Non-dialysis patients with diabetic CKD visiting outpatient's clinics of Siriraj Hospital, the largest tertiary care in Thailand, were asked for participation. Self-administered questionnaire was given to assess medication adherence (the 6-item-medication-taking-behavior measure in Thai), complementary medicine usage, and personal information. Clinical, pharmaceutical, and relevant laboratory data (at current and the last visit of around 12 months) were abstracted from the medical records.

RESULTS

Of the 220 participants eligible (54.1% male, mean age 71.3), 50.9%, 24.1%, and 25% were classified as high-, medium-, and low-medication adherence, respectively. Overall, 24.1% reported self-usage of at least one type of herbal or complementary medicines. The most commonly identified items were cordyceps, cod liver oil, Nan Fui Chao, and turmeric (6 each), with unidentified Thai herbal mixture in 11. On multivariate analysis, late-stage CKD (stage IV-V) was the only independent predictor for low adherence (odds ratio (OR), 5.54; 95% confidence interval (CI), 2.82-10.88). Low adherence was associated with higher blood pressure, lower estimated glomerular filtrate rate (eGFR), and more eGFR decline with greater risk of being rapid CKD progressor (annual eGFR drop >5 mL/min/1.73 m2) [OR, 1.15; 95% CI, 1.06-1.25].

CONCLUSION

Medication taking behavior was a frequently encountered problem in Thai diabetic CKD patients. Increased medication non-adherence was independently predicted by stages of increasing CKD severity, and it was associated with poorer hypertensive control and kidney outcome. Targeting interventions to improve medication adherence should be an important strategy to slow CKD progression among patients with diabetic CKD.

Beliefs about medication and their association with adherence in Chinese patients with non-dialysis chronic kidney disease stages 3-5

There is a scarcity of research into the impact of medication beliefs on adherence in patients with non-dialysis chronic kidney disease (CKD). This study is to determine the psychometric properties of the Chinese version of the Beliefs about Medicines Questionnaire (BMQ)-Specific among patients with non-dialysis CKD stages 3-5, and to assess the beliefs of CKD patients and their association with medication adherence.A cross-sectional study was conducted in CKD patients who recruited at the nephrology clinics of Xi'an Central Hospital, Xi'an, Shaanxi, China. The original BMQ-Specific was translated into Chinese. The internal consistency and test-retest reliability of the Chinese version of the BMQ-Specific scale were assessed, while exploratory and confirmatory factor analyses were also applied to determine its reliability and validity. The Kruskal-Wallis test and multiple ordered logistic regression were performed to identify the relationship between beliefs about and adherence to medication among CKD patients.This study recruited 248 patients. Cronbach's α values of the BMQ-Specific necessity and concern subscales were 0.826 and 0.820, respectively, with intraclass correlation coefficients of 0.784 and 0.732. Factor analysis showed that BMQ-Specific provided a good fit to the two-factor model. The adherence of patients was positively correlated with perceived necessity (r = 0.264, P < .001) and negatively correlated with concern (r = -0.294, P < .001). Medication adherence was significantly higher for the accepting group (high necessity and low concern scores) than for the ambivalent group (high necessity and concern scores; β = -0.880, 95% confidence interval [CI] = -1.475 to -0.285), skeptical group (low necessity and high concern scores; β = -2.620, 95% CI = -4.209 to -1.031) and indifferent group (low necessity and concern scores; β = -0.918, 95% CI = -1.724 to -0.112).The Chinese version of BMQ-Specific exhibited satisfactory reliability and validity for use in patients with non-dialysis CKD stages 3-5 and has been demonstrated to be a reliable screening tool for clinicians to use to predict and identify the non-adherence behaviors of patients.

Barriers and Solutions to Improve Therapeutic Adherence from the Perspective of Primary Care and Hospital-Based Physicians

PURPOSE

To identify the barriers affecting treatment adherence in patients with chronic disease and to determine solutions through the physician's opinion of primary care and hospital settings.

METHODS

An observational study using the nominal group technique was performed to reach a consensus from experts. A structured face-to-face group discussion was carried out with physicians with more than 10 years of experience in the subject of treatment adherence/compliance in either the primary care setting or the hospital setting. The experts individually rated a list of questions using the Likert scale and prioritized the top 10 questions to identify barriers and seek solutions afterward. The top 10 questions that obtained the maximum score for both groups of experts were prioritized. During the final discussion group, participating experts analyzed the prioritized items and debated on each problem to reach consensual solutions for improvement.

RESULTS

A total of 17 professionals experts participated in the study, nine of them were from a primary care setting. In the expert group from the primary care setting, the proposed solution for the barrier identified as the highest priority was to simplify treatments, measure adherence and review medication. In the expert group from the hospital setting, the proposed solution for the barrier identified as the highest priority was training on motivational clinical interviews for healthcare workers undergraduate and postgraduate education. Finally, the expert participants proposed implementing an improvement plan with eight key ideas.

CONCLUSION

A consensual improvement plan to facilitate the control of therapeutic adherence in patients with chronic disease was developed, taking into account expert physicians' opinions from primary care and hospital settings about barriers and solutions to address therapeutic adherence in patients with chronic disease.

Interventions Incorporating Therapeutic Alliance to Improve Medication Adherence in Black Patients with Diabetes, Hypertension and Kidney Disease: A Systematic Review

BACKGROUND

Black Americans have a disproportionately increased risk of diabetes, hypertension, and kidney disease, and higher associated morbidity, mortality, and hospitalization rates than their White peers. Structural racism amplifies these disparities, and negatively impacts self-care including medication adherence, critical to chronic disease management. Systematic evidence of successful interventions to improve medication adherence in Black patients with diabetes, hypertension, and kidney disease is lacking. Knowledge of the impact of therapeutic alliance, ie, the unique relationship between patients and providers, which optimizes outcomes especially for minority populations, is unclear. The role and application of behavioral theories in successful development of medication adherence interventions specific to this context also remains unclear.

OBJECTIVE

To evaluate the existing evidence on the salience of a therapeutic alliance in effective interventions to improve medication adherence in Black patients with diabetes, hypertension, or kidney disease.

DATA SOURCES

Medline (via PubMed), EMBASE (OvidSP), Cumulative Index of Nursing and Allied Health Literature (CINAHL) (EBSCOhost), and PsycINFO (ProQuest) databases.

REVIEW METHODS

Only randomized clinical trials and pre/post intervention studies published in English between 2009 and 2022 with a proportion of Black patients greater than 25% were included. Narrative synthesis was done.

RESULTS

Eleven intervention studies met the study criteria and eight of those studies had all-Black samples. Medication adherence outcome measures were heterogenous. Five out of six studies which effectively improved medication adherence, incorporated therapeutic alliance. Seven studies informed by behavioral theories led to significant improvement in medication adherence.

DISCUSSION/CONCLUSION

Study findings suggest that therapeutic alliance-based interventions are effective in improving medication adherence in Black patients with diabetes and hypertension. Further research to test the efficacy of therapeutic alliance-based interventions to improve medication adherence in Black patients should ideally incorporate cultural adaptation, theoretical framework, face-to-face delivery mode, and convenient locations.

An Observational Cohort Study to Evaluate the Impact of a Tailored Medicines Optimisation Service on Medication Use, Accident and Emergency Department Visits, and Admissions Among Patients Identified with Medication Support Needs in Secondary Care

PURPOSE

Quantifying the impact of pharmacy interventions, such as tailored medicines optimisation, can be challenging owing to the sometimes-indirect nature of their effect on patient outcomes such A&E (Accident & Emergency) attendance, hospital admission and length of stay. This study aimed to assess the impact of the, Lewisham Integrated Medicines Optimisation Service (LIMOS) on medicines self-management, A&E attendances and hospital admissions.

PATIENTS AND METHODS

The study was conducted as a retrospective and prospective observational evaluation of patients referred to LIMOS at University Hospital Lewisham between April and September 2016. Only patients with an appropriate referral that received a LIMOS intervention within the study period were considered eligible. The main outcomes examined pre- and post-LIMOS included medicines self-management, A&E attendance, number of admissions, as well as length of stay.

RESULTS

Data were collected for a total of 193 patients. Over half (56.4%, n = 109) identified as female with a mean age of 78 years at the time of referral. The number of hospital admissions decreased significantly post-LIMOS (-0.36 ± 1.87, 95% CI -0.63-0.10). Furthermore, the mean reduction in length of stay was significant and decreased by over a week (19.58 vs 11.09 days post-LIMOS, -7.67 ± 48.57, 95% CI -14.57--0.78). There was a significant increase in A&E visits observed post-intervention (0.78 ± 1.93, 95% CI 0.50-1.06); however, the majority (63%, n =165/261) occurred over 90 days post-intervention. There was a significant reduction in the number of patients self-managing medication post-LIMOS, with the number of patients receiving additional support with their medication increasing (-0.38 ± 0.50, 95% CI -0.45--0.31). LIMOS, therefore, successfully identified patients who were unable to manage their medicines.

CONCLUSION

Specialist pharmacy interventions, which include support with medicines management, have a positive impact on admission avoidance and length of hospital stay.

Exploring the Agreement Between Self-Reported Medication Adherence and Pharmacy Refill-Based Measures in Patients with Kidney Disease

AIM

To assess the quantitative and categorical agreement between two methods of measuring medication adherence: pharmacy refill-based medication possession rates and self-reported medication adherence scale.

BACKGROUND

Categorisation of adherence metrics using empirical cut-off scores can lead to misclassification, which can be overcome by expressing adherence as a continuous variable. Pharmacy refill-based adherence can be reported as actual rates, but the validity of expressing self-reported medication adherence scores as a continuous variable to reflect adherence is unknown and its quantitative agreement with refill-based adherence rates untested.

METHODS

Patients with kidney disease, including dialysis patients, from Illawarra Shoalhaven region of New South Wales, Australia were recruited between January 2015 and June 2016 to this cross-sectional study. Medication adherence was assessed using the self-reported Morisky Medication Adherence Scale (MMAS) and two pharmacy refill-based measures, Medication Possession Ratio (MPR) and Proportion of Days Covered (PDC) for antihypertensives and cardiometabolic drugs. Categorical and quantitative agreement between self-reported adherence and pharmacy refill-based adherence were assessed using tests of trend, analysis of covariance (ANCOVA), Cohen's kappa and Bland-Altman analysis.

RESULTS

We recruited 113 patients. There was a significant declining trend of MPR (p < 0.001) and PDC (<0.001 for antihypertensives, p = 0.004 for cardiometabolic) scores among categories with worsening MMAS adherence. Adjusted ANCOVA showed significant association between self-report and pharmacy refill-based adherence (p < 0.001). Weighted Cohen's kappa statistics showed fair agreement between the self-report and pharmacy refill-based categories. Bland-Altman's analysis showed less than 5% of cases were outside the limits of agreement (-0.36 to 0.27) and the bias for MMAS was negative (-0.05 to -0.09), indicating MMAS did not overestimate adherence.

CONCLUSION

There is modest agreement between pharmacy refill-based measures and self-report MMAS measures when assessed categorically or quantitatively. Assessing adherence as a continuous variable should be considered to overcome the challenges associated with categorization of adherence based on arbitrary thresholds.

Assessment of Dietary Folate Intake and Pill Burden among Saudi Patients on Maintenance Hemodialysis

The aim of this study was to assess the adequacy of dietary folate intake and perceptions of pill burden among Saudi patients on maintenance hemodialysis (MHD). This was a cross-sectional study of adults (>18 years) on MHD (>3 months) attending the dialysis unit at King Saud University Medical City. Patient demographics, dietary folic acid intake, and perceptions of pill burden were collected. Fifty-four patients met the eligibility criteria, with a mean age of 57 ± 15.5 years. The majority were females (63%), and the most prevalent comorbidities were diabetes (43%) and hypertension (76%). The average number of medications/patients was 11 ± 2.9, and most patients were receiving folate supplementation (68.5%). The average dietary folate intake was 823 ± 530 mcg/day. Pill burden was bothersome, primarily due to taking too many medications (57%) while taking medications at the workplace was the least bothersome burden (17%). The reported high pill burden and adequate dietary folate intake by Saudi patients on MHD indicates that the omission of folate supplementation may be advantageous for this special population.

Adherence to Antiplatelet Medications among Persistent and Non-Persistent Older Patients with Peripheral Arterial Disease

Secondary prevention of peripheral arterial disease (PAD) includes administration of antiplatelet agents, and adherence to medication is a requirement for an effective treatment. The aim of this study was to analyse adherence measured using the proportion of days covered (PDC) index separately in persistent and non-persistent patients, and to identify patient- and medication-related characteristics associated with non-adherence in these patient groups. The study cohort of 9178 patients aged ≥ 65 years in whom PAD was diagnosed in 1/–12/2012 included 6146 persistent and 3032 non-persistent patients. Non-adherence was identified as PDC < 80%. Characteristics associated with non-adherence were determined using the binary logistic regression model. In the group of persistent patients, 15.3% of subjects were identified as non-adherent, while among non-persistent patients, 26.9% of subjects were non-adherent to antiplatelet medication. Administration of dual antiplatelet therapy (aspirin and clopidogrel) and a general practitioner as index prescriber were associated with adherence in both patient groups. Our study revealed a relatively high proportion of adherent patients not only in the group of persistent patients but also in the group of non-persistent patients before discontinuation. These results indicate that most non-persistent PAD patients discontinue antiplatelet treatment rapidly after a certain period of adherence.

Self-Reported Medication Use and Urinary Drug Metabolites in the German Chronic Kidney Disease (GCKD) Study

BACKGROUND

Polypharmacy is common among patients with CKD, but little is known about the urinary excretion of many drugs and their metabolites among patients with CKD.

METHODS

To evaluate self-reported medication use in relation to urine drug metabolite levels in a large cohort of patients with CKD, the German Chronic Kidney Disease study, we ascertained self-reported use of 158 substances and 41 medication groups, and coded active ingredients according to the Anatomical Therapeutic Chemical Classification System. We used a nontargeted mass spectrometry-based approach to quantify metabolites in urine; calculated specificity, sensitivity, and accuracy of medication use and corresponding metabolite measurements; and used multivariable regression models to evaluate associations and prescription patterns.

RESULTS

Among 4885 participants, there were 108 medication-drug metabolite pairs on the basis of reported medication use and 78 drug metabolites. Accuracy was excellent for measurements of 36 individual substances in which the unchanged drug was measured in urine (median, 98.5%; range, 61.1%-100%). For 66 pairs of substances and their related drug metabolites, median measurement-based specificity and sensitivity were 99.2% (range, 84.0%-100%) and 71.7% (range, 1.2%-100%), respectively. Commonly prescribed medications for hypertension and cardiovascular risk reduction-including angiotensin II receptor blockers, calcium channel blockers, and metoprolol-showed high sensitivity and specificity. Although self-reported use of prescribed analgesics (acetaminophen, ibuprofen) was <3% each, drug metabolite levels indicated higher usage (acetaminophen, 10%-26%; ibuprofen, 10%-18%).

CONCLUSIONS

This comprehensive screen of associations between urine drug metabolite levels and self-reported medication use supports the use of pharmacometabolomics to assess medication adherence and prescription patterns in persons with CKD, and indicates under-reported use of medications available over the counter, such as analgesics.

Overexpression of MnSOD Protects against Cold Storage-Induced Mitochondrial Injury but Not against OMA1-Dependent OPA1 Proteolytic Processing in Rat Renal Proximal Tubular Cells

Kidneys from deceased donors undergo cold storage (CS) preservation before transplantation. Although CS is a clinical necessity for extending organ quality preservation, CS causes mitochondrial and renal injury. Specifically, many studies, including our own, have shown that the triggering event of CS-induced renal injury is mitochondrial reactive oxygen species (mROS). Here, we explored the role of OMA1-depedent OPA1 proteolytic processing in rat kidney proximal tubular epithelial (NRK) cells in an in vitro model of renal CS (18 h), followed by rewarming (6 h) (CS + RW). The involvement of mROS was evaluated by stably overexpressing manganese superoxide dismutase (MnSOD), an essential mitochondrial antioxidant enzyme, in NRK cells. Western blots detected rapid OPA1 proteolytic processing and a decrease in ATP-dependent cell viability in NRK cells subjected to CS + RW compared to control cells. Small interfering RNA (siRNA) knockdown of OMA1 reduced proteolytic processing of OPA1, suggesting that OMA1 is responsible for OPA1 proteolytic processing during CS + RW-induced renal injury. Overexpression of MnSOD during CS + RW reduced cell death, mitochondrial respiratory dysfunction, and ATP-dependent cell viability, but it did not prevent OMA1-dependent OPA1 processing. These data show for the first time that OMA1 is responsible for proteolytically cleaving OPA1 in a redox-independent manner during renal cell CS.

Electronic Monitoring Feedback for Improving Medication Adherence and Clinical Outcomes in Early Rheumatoid Arthritis: A Randomized Clinical Trial

BACKGROUND

Non-adherence to medication (range 30-107%) is a major issue in patients with rheumatoid arthritis (RA). Previous research has shown that electronic monitoring feedback (EMF) might be an effective strategy to improve medication adherence in chronic conditions. Therefore, this study investigated the effectiveness of electronic monitoring feedback in patients with early RA to improve medication adherence and clinical outcomes compared to usual care.

METHODS

An open-label randomized clinical trial was performed to compare EMF with standard care during a 12-month follow-up period on two sites of the Sint Maartenskliniek (Nijmegen and Boxmeer) in the Netherlands. Patients were eligible if they: (1) had a (working) diagnosis of early RA, (2) were currently using methotrexate, (3) were aged ≥18 years, and (4) had a life expectancy of ≥12 months. Primary outcome was the difference in proportion of non-adherent patients measured with the Compliance Questionnaire on Rheumatology after 12 months. Secondary outcomes were beliefs about medicines, medication adherence measured with the MMAS-8®, patients' health status, prescription of biologic DMARDs, and disease activity after 12 months.

RESULTS

Of the 367 initially-invited patients, 93 patients with early RA agreed to participate in this study. No significant difference was found in the proportion of non-adherent patients between the intervention arm and the usual care arm after 12 months follow-up (60.0% and 61.3%, p=0.93, respectively). Patients in the intervention arm tended to discontinue methotrexate earlier than patients in the usual care arm (median time in weeks: 15.7 (9.1-33.6) and 21.9 (19-28.4), respectively, p=0.31), whereas patients in the usual care arm tended to initiate biologic DMARDs earlier than those in the intervention arm (median time in weeks: 11.9 (5.7-22) and 17 (9.9-40.9), respectively, p=0.55).

CONCLUSION

This study illustrates the challenge of targeting non-adherence with EMF in patients with early RA and shares important lessons learned about designing adherence intervention trials with respect to study attrition, accounting for drug survival, intervention fidelity, intervention uptake, and technical aspects.

Factors associated with the frequency of antihypertensive drug adjustments in chronic kidney disease patients: a multicentre, 2-year retrospective study

Background Optimum antihypertensive drug effect in chronic kidney disease is important to mitigate disease progression. As frequent adjustments to antihypertensive drugs might lead to problems that may affect their effectiveness, the modifiable factors leading to frequent adjustments of antihypertensive drugs should be identified and addressed. Objective This study aims to identify the factors associated with frequent adjustments to antihypertensive drugs among chronic kidney disease patients receiving routine nephrology care. Setting Nephrology clinics at two Malaysian tertiary hospitals. Method This multi-centre, retrospective cohort study included adult patients under chronic kidney disease clinic follow-up. Demographic data, clinical information, laboratory data and medication characteristics from 2018 to 2020 were collected. Multiple logistic regression was used to identify the factors associated with frequent adjustments to antihypertensive drugs (≥ 1 per year). Main outcome measure Frequent adjustments to antihypertensive drugs. Results From 671 patients included in the study, 219 (32.6%) had frequent adjustments to antihypertensive drugs. Frequent adjustment to antihypertensive drugs was more likely to occur with follow-ups in multiple institutions (adjusted Odds Ratio [aOR] 1.244, 95% confidence interval [CI] 1.012, 1.530), use of traditional/complementary medicine (aOR 2.058, 95% CI 1.058, 4.001), poor medication adherence (aOR 1.563, 95% CI 1.037, 2.357), change in estimated glomerular filtration rate (aOR 0.970, 95% CI 0.951, 0.990), and albuminuria categories A2 (aOR 2.173, 95% CI 1.311, 3.603) and A3 (aOR 2.117, 95% CI 1.349, 3.322), after controlling for confounding factors. Conclusion This work highlights the importance of close monitoring of patients requiring initial adjustments to antihypertensive drugs. Antihypertensive drug adjustments may indicate events that could contribute to poorer outcomes in the future.