W TESFAYE1, RL CASTELINO2, BC WIMMER1, C McKERCHER3, MD JOSE1,3,4, AL NEIL3, ST ZAIDI1
1School of Medicine, University of Tasmania, Hobart, Tasmania; 2The University of Sydney, Sydney, New South Wales; 3Menzies Institute for Medical Research, Hobart, Tasmania; 4Royal Hobart Hospital, Hobart, Tasmania
Aim: To examine the relationship between medication burden, adherence and health-related quality of life (HRQoL).
Background: Poor medication adherence in patients with advanced chronic kidney disease (CKD) is associated with disease progression and mortality. However, little is known about the associations between medication burden, adherence and HRQoL.
Methods: Medication burden, actual and perceived, was measured using the Medication Regimen Complexity Index (MRCI) and the perceived Burden of Oral Therapy (BOT). Medication adherence was assessed using the Tool for Adherence Behaviour Screening (TABS). HRQoL was measured using the Kidney Disease and Quality of Life Short-Form, containing disease-specific and generic physical (PCS) and mental (MCS) component summaries, and EuroQol 5 Dimensions 3 Levels (EQ-5D-3L). Associations were examined using Spearman’s rho.
Results: Fifty adults (16 women, 32%) aged ≥18 years (mean 72.0±11.1 years) with CKD (eGFR <30 ml/min/1.73 m2) and not receiving dialysis were recruited via treating physicians. Overall, 418 medications, predominantly cardiovascular agents (38%), were prescribed. Mean number of medications was 8.4±3.8 with a MRCI score of 21.3±10.6 and 48% (n=24) of participants were adherent (TABS). Actual and perceived medication burden were associated with EQ-5D-3L (r=-0.34, p<0.01; r=-0.32, p<0.01). While BOT was correlated with age (r=-0.43, p<0.05), number of medications (r=-0.33, p<0.05) and MRCI (r=-0.34, p<0.05) were associated with PCS. Similarly, higher adherence scores were associated with lower scores of PCS (r=-0.40, p<0.01).
Conclusions: Participants who self-reported higher medication adherence tended to report lower perceived physical health (PCS). Those who had a higher medication burden also self-reported lower HRQoL (EQ-5D-3L). Exploring the determinants of adherence and their interplay with different aspects of HRQoL may help to understand the drivers of adherence in people with CKD.