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Nonadherence to Medication Therapy in Haemodialysis Patients: A Systematic Review


Ghimire, S and Castelino, RL and Lioufas, NM and Peterson, GM and Zaidi, STR, Nonadherence to Medication Therapy in Haemodialysis Patients: A Systematic Review, PloS one, 10, (12) Article e0144119. ISSN 1932-6203 (2015) [Refereed Article]


Copyright Statement

Copyright 2015 Ghimire et al. Licensed under Creative Commons Attribution 4.0 International (CC BY 4.0)

DOI: doi:10.1371/journal.pone.0144119


Background: End-stage kidney disease (ESKD) patients are often prescribed multiple medications. Together with a demanding weekly schedule of dialysis sessions, increased number of medicines and associated regimen complexity pre-dispose them at high risk of medication nonadherence. This review summarizes existing literature on nonadherence and identifies factors associated with nonadherence to medication therapy in patients undergoing haemodialysis.

Methods: A comprehensive search of PubMed, Embase, CINAHL, PsycInfo, and Cochrane Database of Systematic Reviews covering the period from 1970 through November 2014 was performed following a predefined inclusion and exclusion criteria. Reference lists from relevant materials were reviewed. Data on study characteristics, measures of nonadherence, prevalence rates and factors associated with nonadherence were collected. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines was followed in conducting this systematic review.

Results: Of 920 relevant publications, 44 were included. The prevalence of medication nonadherence varied from 12.5% to 98.6%, with widespread heterogeneity in measures and definitions employed. Most common patient-related factors significantly associated with nonadherence were younger age, non-Caucasian ethnicity, illness interfering family life, being a smoker, and living single and being divorced or widowed. Similarly, disease-related factors include longevity of haemodialysis, recurrent hospitalization, depressive symptoms and having concomitant illness like diabetes and hypertension. Medication-related factors such as daily tablet count, total pill burden, number of phosphate binders prescribed and complexity of medication regimen were also associated with poor adherence.

Conclusions: A number of patient-, disease-, and medication-related factors are associated with medication nonadherence in haemodialysis patients. Clinicians should be aware of such factors so that adherence to medications can be optimised in haemodialysis patients. Future research should be directed towards well-designed prospective longitudinal studies developing standard definitions and validating available measurement tools, while focusing on the role of additional factors such as psychosocial and behavioural factors in predicting nonadherence to medications.

Item Details

Item Type:Refereed Article
Keywords:adherence, medications, quality of life, dialysis
Research Division:Biomedical and Clinical Sciences
Research Group:Pharmacology and pharmaceutical sciences
Research Field:Clinical pharmacy and pharmacy practice
Objective Division:Health
Objective Group:Evaluation of health and support services
Objective Field:Evaluation of health outcomes
UTAS Author:Ghimire, S (Mr Saurav Ghimire)
UTAS Author:Castelino, RL (Dr Ronald Castelino)
UTAS Author:Peterson, GM (Professor Gregory Peterson)
UTAS Author:Zaidi, STR (Dr Tabish Razi Zaidi)
ID Code:105083
Year Published:2015
Web of Science® Times Cited:113
Deposited By:Pharmacy
Deposited On:2015-12-07
Last Modified:2017-11-02
Downloads:335 View Download Statistics

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