Evaluation of medication adherence in chronic kidney disease patients with and without hemodialysis

Abstract

Background: Poor long-term adherence and persistence to pharmacological therapy is widely acknowledged as one of the primary clinical difficulties in the management of chronic diseases such as chronic kidney disease (CKD). The present study was aimed to measure treatment adherence using the Morisky Medication Adherence Scale (MMAS)-8 questionnaire in CKD patients with or without hemodialysis. Methodology: It was a cross-sectional study conducted in 120 clinically stable CKD patients with Stage 3 onward with or without hemodialysis. The sociodemographic and clinical characteristics of participants were collected in a predesigned format. Individual participants were scheduled for interviews and asked to complete inventory questionnaires. Medication adherence was assessed using a validated diagnostic tool MMAS-8 questionnaire. Results: Out of 120 individuals, the average number of medicines prescribed per prescription was 5.63 ± 2.22 and 4.65 ± 1.72 in the dialysis and nondialysis groups, respectively. Patients on dialysis had a higher pill burden than nondialysis patients, with more than three-fourths (78.3%) of them taking more than five medications every prescription. Low, moderate, and good adherence were reported in 61.7% (n = 37) versus 26.7% (n = 16), 33.3% (n = 20) versus 71.7% (n = 43), and 5% (n = 3) versus 1.6% (n = 1) of patients with and without dialysis, respectively, in MMAS-8. The most often reported nonadherence behaviors were forgetting to take medications, forgetting to pack medications while traveling, and feeling pressured to follow a treatment plan. There was an association between the dialysis and nondialysis groups in education level, employment, and pill load among patients with low adherence. Conclusion: Majority of the respondents (more than 90%) reported low-to-moderate adherence in both dialysis and nondialysis populations. Physicians and all other health-care professionals should work together to reduce the obstacles to good adherence by enhancing communication, reducing the burden of taking a lot of pills, and, if possible, by occasionally checking on patient adherence when there is suspicion of poor adherence.