Fissell Rachel B, Karaboyas Angelo, Bieber Brian A, Sen Ananda, Li Yun, Lopes Antonio A, Akiba Takashi, Bommer Jürgen, Ethier Jean, Jadoul Michel, Pisoni Ronald L, Robinson Bruce M, Tentori Francesca
Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Arbor Research Collaborative for Health, Ann Arbor, Michigan, USA.
Hemodial Int. 2016 Jan;20(1):38-49. doi: 10.1111/hdi.12315. Epub 2015 May 14.
Because of multiple comorbidities, hemodialysis (HD) patients are prescribed many oral medications, including phosphate binders (PBs), often resulting in a high "pill burden." Using data from the international Dialysis Outcomes and Practice Patterns Study (DOPPS), we assessed associations between PB pill burden, patient-reported PB non-adherence, and levels of serum phosphorus (SPhos) and parathyroid hormone (PTH) using standard regression analyses. The study included data collected from 5262 HD patients from dialysis units participating in the DOPPS in 12 countries. PB prescription ranged from a mean of 7.4 pills per day in the United States to 3.9 pills per day in France. About half of the patients were prescribed at least 6 PB pills per day, and 13% were prescribed at least 12 PB pills per day. Overall, the proportion of patients who reported skipping PBs at least once in the past month was 45% overall, ranging from 33% in Belgium to 57% in the United States. There was a trend toward greater PB non-adherence and a higher number of prescribed PB pills per day. Non-adherence to PB prescription was associated with high SPhos (>5.5 mg/dL) and PTH (>600 pg/mL). Adherence to PB is a challenge for many HD patients and may be related to the number of PB pills prescribed. Prescription of a simplified PB regimen could improve patient adherence and perhaps improve SPhos and PTH levels.
由于存在多种合并症，血液透析（HD）患者需服用多种口服药物，包括磷结合剂（PBs），这常常导致较高的“药丸负担”。我们利用国际透析结果和实践模式研究（DOPPS）的数据，通过标准回归分析评估了PB药丸负担、患者报告的PB不依从性与血清磷（SPhos）和甲状旁腺激素（PTH）水平之间的关联。该研究纳入了来自12个国家参与DOPPS的透析单位的5262例HD患者收集的数据。PB的处方量从美国的平均每天7.4片到法国的平均每天3.9片不等。约一半的患者每天至少服用6片PB，13%的患者每天至少服用12片PB。总体而言，在过去一个月中报告至少有一次漏服PB的患者比例总体为45%，从比利时的33%到美国的57%不等。存在PB不依从性增加以及每天开具的PB药丸数量增多的趋势。PB处方不依从与高SPhos（>5.5mg/dL）和PTH（>600pg/mL）相关。对许多HD患者来说，坚持服用PB是一项挑战，这可能与开具的PB药丸数量有关。简化PB治疗方案的处方可能会提高患者的依从性，并可能改善SPhos和PTH水平。
