Summary

A study of the number of pills kidney dialysis patients take, and their adherence to treatment, reveals that this is a real issue in quality of life.

Taking a lot of pills, particularly those meant to control phosphate levels, is cited by many as having an adverse impact on the way they see their health.

Introduction

People with chronic, long-term conditions often have to take a lot of medication. Each medicine has potential side effects and drugs may also interact with one another. While wise prescribing can play a vital role in managing a patient’s condition, sometimes the ‘pill burden’ has a negative effect on the patient. One effect is that they give up taking their medication as prescribed, which might have a negative effect on health. A group for which this may be especially so is those on kidney dialysis who tend to have to take more drugs than patients with most other chronic diseases.

What was done

Researches at the Los Angeles Biomedical Research Institute studied a group of 233 chronic dialysis patients from three clinics in the United States. They recorded the number and type of medications the participants were taking as well as their perceived health-related quality of life.

What was found

Patients were taking an average of 19 pills per day and a quarter of them were on more than 25 pills per day. Those with a higher ‘pill burden’ had lower perceived physical health. Drugs called phosphate binders, that control the level of phosphorus in the blood, accounted for around half of the pill burden. And 62% of patients were not taking these drugs as prescribed. In fact, the more phosphate binders were prescribed, the less likely it was that the patient was taking them as directed and the less likely their blood phosphorus was to be under control.

What this study means

The patients’ poorer health-related quality of life may be related to their blood phosphorus levels not being controlled. And this, in turn, is probably related to their not taking their pills. Therefore, the pill burden among dialysis patients must be addressed to try to get the right balance between managing the kidney condition and preserving the patient’s quality of life – and the role phosphate binders play in this delicate equation should be given particular attention.

Source

Mehrotra R, Chiu Y-W et al Pill burden, adherence, hyperphosphatemia and quality of life in maintenance dialysis patients Clinical Journal of the American Society of Nephrology online May 7 2009 doi10.2215/CJN.00290109