TY - JOUR
T1 - Self-reported Medication Adherence and CKD Progression
AU - CRIC Study Investigators
AU - Cedillo-Couvert, Esteban A.
AU - Ricardo, Ana C.
AU - Chen, Jinsong
AU - Cohan, Janet
AU - Fischer, Michael J.
AU - Krousel-Wood, Marie
AU - Kusek, John W.
AU - Lederer, Swati
AU - Lustigova, Eva
AU - Ojo, Akinlolu
AU - Porter, Anna C.
AU - Sharp, Lisa K.
AU - Sondheimer, James
AU - Diamantidis, Clarissa
AU - Wang, Xue
AU - Roy, Jason
AU - Lash, James P.
AU - Appel, Lawrence J.
AU - Feldman, Harold I.
AU - Go, Alan S.
AU - He, Jiang
AU - Kusek, John W.
AU - Lash, James P.
AU - Rahman, Mahboob
AU - Rao, Panduranga S.
AU - Townsend, Raymond R.
N1 - Funding Information:
Funding for the CRIC Study was obtained under a cooperative agreement from the U.S. National Institute of Diabetes and Digestive and Kidney Diseases (U01DK060990, U01DK060984, U01DK061022, U01DK061021, U01DK061028, U01DK060980, U01DK060963, and U01DK060902). In addition, this work was supported in part by: the Perelman School of Medicine at the University of Pennsylvania Clinical and Translational Science Award NIH/NCATS UL1TR000003, Johns Hopkins University UL1 TR-000424, University of Maryland GCRC M01 RR-16500, Clinical and Translational Science Collaborative of Cleveland, UL1TR000439 from the National Center for Advancing Translational Sciences (NCATS) component of the National Institutes of Health and NIH roadmap for Medical Research, Michigan Institute for Clinical and Health Research (MICHR) UL1TR000433, University of Illinois at Chicago CTSA UL1RR029879, Tulane University Translational Research in Hypertension and Renal Biology P30GM103337, Kaiser Permanente Northern California NIH/NCRR UCSF-CTSI UL1 RR-024131. JPL is funded by the NIDDK K24DK092290. EAC-C is funded by a Research Supplement to Promote Diversity in Health-Related Research U01-DK060980. ACC is funded by NIDDK K23DK094829.
Publisher Copyright:
© 2018 International Society of Nephrology
PY - 2018/5
Y1 - 2018/5
N2 - 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.
AB - 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.
KW - CKD
KW - death
KW - medication adherence
KW - progression
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U2 - 10.1016/j.ekir.2018.01.007
DO - 10.1016/j.ekir.2018.01.007
M3 - Article
C2 - 29854972
AN - SCOPUS:85044256402
SN - 2468-0249
VL - 3
SP - 645
EP - 651
JO - Kidney International Reports
JF - Kidney International Reports
IS - 3
ER -