Self-reported Medication Adherence and CKD Progression

Esteban A Cedillo-Couvert, Ana C Ricardo, Jinsong Chen, Janet Cohan, Michael J Fischer, Marie Krousel-Wood, John W Kusek, Swati Lederer, Eva Lustigova, Akinlolu Ojo, Anna C Porter, Lisa K Sharp, James Sondheimer, Clarissa Diamantidis, Xue Wang, Jason Roy, James P Lash, CRIC Study Investigators, Lawrence J Appel, Harold I Feldman, Alan S Go, Jiang He, John W Kusek, James P Lash, Mahboob Rahman, Panduranga S Rao, Raymond R Townsend, Esteban A Cedillo-Couvert, Ana C Ricardo, Jinsong Chen, Janet Cohan, Michael J Fischer, Marie Krousel-Wood, John W Kusek, Swati Lederer, Eva Lustigova, Akinlolu Ojo, Anna C Porter, Lisa K Sharp, James Sondheimer, Clarissa Diamantidis, Xue Wang, Jason Roy, James P Lash, CRIC Study Investigators, Lawrence J Appel, Harold I Feldman, Alan S Go, Jiang He, John W Kusek, James P Lash, Mahboob Rahman, Panduranga S Rao, Raymond R Townsend

Abstract

Introduction: In the general population, medication nonadherence contributes to poorer outcomes. However, little is known about medication adherence among adults with chronic kidney disease (CKD). We evaluated the association of self-reported medication adherence with CKD progression and all-cause death in patients with CKD.

Methods: In this prospective observational study of 3305 adults with mild-to-moderate CKD enrolled in the Chronic Renal Insufficiency Cohort (CRIC) Study, the baseline self-reported medication adherence was assessed by responses to 3 questions and categorized as high, medium, and low. CKD progression (50% decline in eGFR or incident end-stage renal disease) and all-cause death were measured using multivariable Cox proportional hazards.

Results: Of the patients, 68% were categorized as high adherence, 17% medium adherence, and 15% low adherence. Over a median follow-up of 6 years, there were 969 CKD progression events and 675 deaths. Compared with the high-adherence group, the low-adherence group experienced increased risk for CKD progression (hazard ratio = 1.27, 95% confidence interval = 1.05, 1.54) after adjustment for sociodemographic and clinical factors, cardiovascular medications, number of medication types, and depressive symptoms. A similar association existed between low adherence and all-cause death, but did not reach standard statistical significance (hazard ratio = 1.14 95% confidence interval = 0.88, 1.47).

Conclusion: Baseline self-reported low medication adherence was associated with an increased risk for CKD progression. Future work is needed to better understand the mechanisms underlying this association and to develop interventions to improve adherence.

Keywords: CKD; death; medication adherence; progression.

Figures

Figure 1
Figure 1
Analytic cohort flowchart. CRIC, Chronic Renal Insufficiency Cohort; eGFR, estimated glomerular filtration rate.
Figure 2
Figure 2
Rates of chronic kidney disease (CKD) progression and all-cause death, by level of medication adherence.

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Source: PubMed

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