Cardone Katie E, Manley Harold J, Grabe Darren W, Meola Shari, Hoy Christopher D, Bailie George R
Department of Pharmacy Practice, Albany College of Pharmacy and Health Sciences, Albany, New York, USA.
Hemodial Int. 2011 Apr;15(2):234-42. doi: 10.1111/j.1542-4758.2011.00539.x. Epub 2011 Mar 13.
Medication regimen simplification may improve adherence in end-stage kidney disease. The effect of nocturnal home hemodialysis (NHHD) on medication burden is unknown. A retrospective pilot study of NHHD patients was conducted. Medication information was collected at baseline, NHHD start, and at 3, 6, 12, 18, and 24 months. SF-36 scores were collected at baseline, 6, 12, and 24 months. The number of medications, pill burden, and number of administrations per day were determined. Medication Regimen Complexity Index was used at each time point as a comparator. Medications for anemia, mineral and bone disorders (MBD), cardiovascular (CV) disease, infection, and vitamins were analyzed for number of medications and pill burden. Thirty-five patients were included. Patients used 10.5 ± 4.4 medications at baseline and 11.8 ± 4.7 at the end of the study (P=NS). Regarding the number of medications, anemia medications, anti-infectives, and vitamins increased; MBD and CV medications decreased by the end of the study. Total pill burden did not change over 24 months, nor did anemia pill burden. Mineral bone disorder and CV pill burden decreased, and vitamins and anti-infective pill burden increased. Daily medication administration times decreased significantly from 5.0 ± 1.5 to 3.6 ± 1.5 by 24 months. Switching to NHHD was associated with a significant increase in Medication Regimen Complexity Index at 24 months (P<0.05). SF-36 scores increased significantly once patients began on NHHD. No measure of medication regimen complexity was correlated with the SF-36 score. Medication burden changes over time after starting NHHD. It is unknown what effect NHHD has on adherence or medication costs, and warrants further study in a prospective comparative investigation.
简化药物治疗方案可能会提高终末期肾病患者的依从性。夜间家庭血液透析（NHHD）对药物负担的影响尚不清楚。我们对NHHD患者进行了一项回顾性试点研究。在基线、开始NHHD时以及3、6、12、18和24个月时收集药物信息。在基线、6、12和24个月时收集SF-36评分。确定药物数量、药丸负担和每日给药次数。在每个时间点使用药物治疗方案复杂性指数作为比较指标。分析了用于贫血、矿物质和骨疾病（MBD）、心血管（CV）疾病、感染和维生素的药物数量和药丸负担。共纳入35例患者。患者在基线时使用10.5±4.4种药物，研究结束时使用11.8±4.7种药物（P=无显著性差异）。就药物数量而言，贫血药物、抗感染药物和维生素类药物增加；到研究结束时，MBD和CV药物减少。24个月内总药丸负担没有变化，贫血药丸负担也没有变化。矿物质骨疾病和CV药丸负担减少，维生素和抗感染药丸负担增加。到24个月时，每日药物给药次数从5.0±1.5显著减少至3.6±1.5。到24个月时，改用NHHD与药物治疗方案复杂性指数显著增加相关（P<0.05）。一旦患者开始接受NHHD，SF-36评分显著增加。没有药物治疗方案复杂性的指标与SF-36评分相关。开始NHHD后，药物负担随时间变化。NHHD对依从性或药物成本有何影响尚不清楚，值得在前瞻性比较研究中进一步探讨。
