Potentially modifiable factors associated with non-adherence to phosphate binder use in patients on hemodialysis

BMC Nephrology

Antonio Alberto Lopes³  Gildete Barreto Lopes⁵  Lívia Oliveira⁵  Gabriel Schnitman⁵  Lidiane Dias⁵  Dandara Reis⁵  Angiolina Kraychete⁴  Luciana Ferreira Silva¹  Maria Tereza Silveira Martins² 

[1] Departamento de Ciências da Vida, Universidade do Estado da Bahia, Salvador, Bahia, Brazil;Programa de Pós-Graduação em Medicina e Saúde, Universidade Federal da Bahia, Salvador, BA, Brazil;Departamento de Medicina e Apoio Diagnóstico da Faculdade de Medicina da Bahia, da Universidade Federal da Bahia, Salvador, Bahia, Brazil;Instituto de Nefrologia e Diálise, Salvador, Bahia, Brazil;Núcleo de Epidemiologia Clínica e Medicina Baseada em Evidências, Salvador, Bahia, Brazil

关键词: Adherence;    Phosphate binder;    Hemodialysis;   

Others  :  1082831
DOI  :  10.1186/1471-2369-14-208

 received in 2013-07-10, accepted in 2013-10-01,  发布年份 2013

【 摘 要 】

Background

Despite the evidence that phosphate binder (PB) is associated with improved outcomes many hemodialysis patients do not adhere to prescribed PB regimen. Therefore, barriers to PB adherence should be identified and eliminated. The purpose of this study was to evaluate PB adherence among hemodialysis patients and to explore potentially modifiable factors associated with low PB adherence.

Methods

A cross-sectional study (502 patients) was performed in four dialysis units in Salvador, Brazil, using data from the second phase of the Prospective Study of the Prognosis of Chronic Hemodialysis Patients (PROHEMO). Patients were categorized as adherent or non-adherent to PB based on their responses to a semi-structured questionnaire.

Results

Non-adherence to PB was observed for 65.7% of the patients. After adjustments for numerous covariates, cerebrovascular disease (odds ratio (OR), 3.30; 95% confidence interval (CI), 1.03-10.61), higher PTH (OR per each 300 pg/mL, 1.14; 95% CI, 1.01-1.28), lack of comprehension of the appropriate time to use PB (OR, 7.09; 95% CI, 2.10-23.95) and stopping PB use after feeling better (OR, 4.54; 95% CI, 1.45-14.25) or feeling worse (OR, 11.04; 95% CI, 1.79- 68.03) were significantly associated with PB non-adherence. By contrast, the adjusted odds of PB non-adherence were lower for patients with more years on dialysis (OR by each 2 years, 0.87; 95% CI, 0.80-0.95), with serum phosphorus above 5.5 mg/dL (OR, 0.53; 95% CI 0.34-0.82), who referred that were encouraged by the dialysis staff to be independent (OR, 0.52; 95% CI 0.30-0.90), and reported that the nephrologist explained how PB should be used (OR, 0.20; 95% CI 0.05-0.73).

Conclusion

The results of the present study are encouraging by showing evidence that improvement in the care provided by the dialysis staff and the attending nephrologist may play an important role in reducing the high prevalence of non-adherence to PB in maintenance hemodialysis patients. A new questionnaire is presented and may help to evaluate systematically the patients regarding PB adherence in hemodialysis setting.

【 授权许可】

   
2013 Martins et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Zehnder D, Landray MJ, Wheeler DC, Fraser W, Blackwell L, Nuttall S, Hughes SV, Townend J, Ferro C, Baigent C, Hewison M: Cross-sectional analysis of abnormalities of mineral homeostasis, vitamin D and parathyroid hormone in a cohort of pre-dialysis patients. The chronic renal impairment in Birmingham (CRIB) study. Nephron Clin Pract 2007, 107:c109-c116.
• [2]Covic A, Kothawala P, Bernal M, Robbins S, Chalian A, Goldsmith D: Systematic review of the evidence underlying the association between mineral metabolism disturbances and risk of all-cause mortality, cardiovascular mortality and cardiovascular events in chronic kidney disease. Nephrol Dial Transplant 2009, 24:1506-1523.
• [3]Block AG, Hulbert-Shearon TE, Levin NW, Port FK: Association of serum phosphorus and calcium × phosphate product with mortality risk in chronic haemodialysis patients: a national study. Am J Kidney Dis 1998, 31:607-617.
• [4]Young EW, Albert JM, Satayathum S, Goodkin DA, Pisoni RL, Akiba T, Akizawa T, Kurokawa K, Bommer J, Piera L, Port FK: Predictors and consequences of altered mineral metabolism: the Dialysis Outcomes and Practice Patterns Study. Kidney Int 2005, 67:1179-1187.
• [5]Block GA, Klassen PS, Lazarus JM, Ofsthun N, Lowrie EG, Chertow GM: Mineral metabolism, mortality and morbidity in maintenance hemodialysis. J Am Soc Nephrol 2004, 15:2208-2218.
• [6]Ganesh SK, Stack AG, Levin NW, Hulbert-Shearon T, Port FK: Association of elevated serum PO4, CA X PO4 product and parathyroid hormone with cardiac mortality risk in chronic hemodialysis patients. J Am Soc Nephrol 2001, 12:2131-2138.
• [7]Molony DA, Stephens BW: Derangements in phosphate metabolism in chronic kidney diseases/endstage renal disease: therapeutic considerations. Adv Chronic Kidney Dis 2011, 18:120-131.
• [8]Kidney Disease Improving Global Outcomes (KDIGO) CKD-MBD Work Group: KDIGO clinical practice guideline for the diagnosis, evaluation, prevention, and treatment of chronic kidney disease-mineral and bone disorder (CKD-MBD). Kidney Int Suppl 2009, 113(Suppl):1-130.
• [9]Gotch FA, Panlilio F, Sergeyeva O, Rosales L, Folden T, Kaysen G, Levin NW: A kinetic model of inorganic phosphorus mass balance in hemodialysis therapy. Blood Purif 2003, 21:51-57.
• [10]Tonelli M, Wang W, Hemmelgarn B, Lloyd A, Manns B, Alberta Kidney Disease Network: Phosphate removal with several thrice weekly dialysis methods in overweight hemodialysis patients. Am J Kidney Dis 2009, 54:1108-1115.
• [11]Shinaberger CS, Kilpatrick RD, Regidor DL, McAllister CJ, Greenland S, Kopple JD, Kalantar-Zadeh K: Longitudinal associations between dietary protein intake and survival in hemodialysis patients. Am J Kidney Dis 2006, 16:29-33.
• [12]Isakova T, Gutiérrez OM, Chang Y, Shah A, Tamez H, Smith K, Thadhani R, Wolf M: Phosphorus binders and survival on hemodialysis. J Am Soc Nephrol 2009, 20:388-396.
• [13]Lopes AA, Tong L, Thumma J, Li Y, Fuller DS, Morgenstern H, Bommer J, Kerr PG, Tentori F, Akiba T, Gillespie BW, Robinson BM, Port FK, Pisoni RL: Phosphate binder use and mortality among hemodialysis patients in the Dialysis Outcomes and Practice Patterns Study (DOPPS): evaluation of possible confounding by nutritional status. Am J Kidney Dis 2012, 60:90-101.
• [14]Arenas MD, Malek T, Álvarez-Ude F, Gil MT, Moledous A, Reig-Ferrer A: Phosphorus binders: preferences of patients on haemodialysis and its impact on treatment compliance and phosphorus control. Nefrologia 2010, 30:522-530.
• [15]Chiu YW, Teitelbaum I, Misra M, de Leon EM, Adzize T, Mehrotra R: Pill burden, adherence, hyperphosphatemia, and quality of life in maintenance dialysis patients. Clin J Am Soc Nephrol 2009, 4:1089-1096.
• [16]Karamanidou C, Clatworthy J, Weinman J, Horne R: A systematic review of the prevalence and determinants of nonadherence to phosphate binder medication in patients with end-stage renal disease. BMC Nephrol 2008, 9:2. BioMed Central Full Text
• [17]Martins MT, Silva LF, Martins MT, Matos CM, Melo NA, Azevedo MF, Travessa IE, Amoedo MK, Fernandes PA, Nogueira FC, Lopes GB, Lopes AA: Prescription of phosphorus binders and calcitriol for chronic hemodialysis patients. Rev Assoc Med Bras 2009, 55:70-74.
• [18]Associação Brasileira de Institutos de Pesquisa de Mercado: Pesquisa do perfil sócio-econômico e cultural do estudante de graduação das IFES brasileiras: classificação socioeconômica critério Abipeme. http://www.ufrn.br/sites/fonaprace/perfil_anexo3.doc webcite
• [19]Duarte PS, Miyazaki MCQS, Ciconelli RM, Sesso R: Translation and cultural adaptation of the quality of life assessment instrument for chronic renal patients (KDQOL-SF)]. Rev Assoc Med Bras 2003, 49:375-381.
• [20]Silveira DX, Jorge MR: Propriedades psicométricas da escala de rastreamento populacional para depressão CES-D em populações clínica e não clínica de adolescentes e adultos jovens. Psiq Clin 1998, 25:251-261.
• [21]Stamatakis MK, Pecora PG, Gunel E: Factors influencing adherence in chronic dialysis patients with hiperphosphatemia. J Renal Nutr 1997, 7:144-148.
• [22]National Kidney Foundation: K/DOQI clinical practice guidelines for bone and mineral metabolism and disease in chronic kidney disease. Am J Kidney Dis 2003, 42(Suppl 3):1-201.
• [23]Wang S, Alfieri T, Ramakrishnan K, Braunhofer P, Newsome BA: Serum phosphorus levels and pill burden are inversely associated with adherence in patients on hemodialysis. Nephrol Dial Transplant 2013, 0:1-9.