Parker Krystina, Bull-Engelstad Ingrid, Aasebø Willy, von der Lippe Nanna, Reier-Nilsen Morten, Os Ingrid, Stavem Knut
Department of Nephrology, Medical Division, Akershus University Hospital, Lørenskog, Norway.
Faculty of Medicine, University of Oslo, Institute of Clinical Medicine, Oslo, Norway.
Hemodial Int. 2019 Jul;23(3):333-342. doi: 10.1111/hdi.12739. Epub 2019 Feb 19.
Elderly patients with chronic kidney disease (CKD) stage 5 with or without dialysis treatment usually have concomitant comorbidities, which often result in multiple pharmacological therapies. This study aimed to identify factors associated with medication complexity and medication adherence, as well as the association between medication complexity and medication adherence, in elderly patients with CKD.
This prospective study involved elderly patients with CKD stage 5 (estimated glomerular filtration rate < 15 ml/min/1.73m ) recruited from three Norwegian hospitals. Most of the patients were receiving either hemodialysis or peritoneal dialysis. We used the Medication Regimen Complexity Index (MRCI) to assess the complexity of medication regimens, and the eight-item Morisky Medication Adherence Scale (MMAS-8) to assess medication adherence. Factors associated with the MRCI and MMAS-8 score were determined using either multivariable linear or ordinal logistic regression analysis.
In total, 157 patients aged 76 ± 7.2 years (mean ± SD) were included in the analysis. Their overall MRCI score was 22.8 ± 7.7. In multivariable linear regression analyses, female sex (P = 0.044), Charlson Comorbidity Index of 4 or 5 (P = 0.029) and using several categories of phosphate binders (P < 0.001 to 0.04) were associated with the MRCI. Moderate or high adherence (MMAS-8 score ≥ 6) was demonstrated by 83% of the patients. The multivariable logistic regression analyses found no association of medication complexity, age or other variables with medication adherence as assessed using the MMAS-8.
Female sex, comorbidity and use of phosphate binders were associated with more-complex medication regimens in this population. No association was found between medication regimen complexity, phosphate binders or age and medication adherence. These findings are based on a homogeneous elderly group, and so future studies should test if they can be generalized to patients of all ages with CKD.
患有慢性肾脏病（CKD）5期且接受或未接受透析治疗的老年患者通常伴有合并症，这往往需要多种药物治疗。本研究旨在确定CKD老年患者中与用药复杂性和用药依从性相关的因素，以及用药复杂性与用药依从性之间的关联。
这项前瞻性研究纳入了从挪威三家医院招募的CKD 5期老年患者（估计肾小球滤过率<15 ml/min/1.73m²）。大多数患者接受血液透析或腹膜透析。我们使用药物治疗方案复杂性指数（MRCI）评估药物治疗方案的复杂性，并使用八项Morisky用药依从性量表（MMAS-8）评估用药依从性。使用多变量线性或有序逻辑回归分析确定与MRCI和MMAS-8评分相关的因素。
总共157名年龄为76±7.2岁（均值±标准差）的患者纳入分析。他们的总体MRCI评分为22.8±7.7。在多变量线性回归分析中，女性（P = 0.044）、Charlson合并症指数为4或5（P = 0.029）以及使用多种类型的磷结合剂（P<0.001至0.04）与MRCI相关。83%的患者表现出中度或高度依从性（MMAS-8评分≥6）。多变量逻辑回归分析未发现用药复杂性、年龄或其他变量与使用MMAS-8评估的用药依从性之间存在关联。
在该人群中，女性、合并症和磷结合剂的使用与更复杂的药物治疗方案相关。未发现药物治疗方案复杂性、磷结合剂或年龄与用药依从性之间存在关联。这些发现基于一个同质化的老年群体，因此未来的研究应测试这些发现是否可以推广到所有年龄段的CKD患者。
