Kidney Week

Abstract: TH-PO1041

Effects of Mineral Bone Disorder Medication Non-Adherence on Dialysis Patient Outcomes

Session Information

• Mineral Disease: Ca/Mg/PO4
  November 02, 2017 | Location: Hall H, Morial Convention Center
  Abstract Time: 10:00 AM - 10:00 AM

Category: Mineral Disease

• 1201 Mineral Disease: Ca/Mg/PO4

Authors

• Jiao, Yue, Fresenius Medical Care North America, Waltham, Massachusetts, United States

Yue Jiao,

• Dias, Michelle, Fresenius Rx, Franklin, Tennessee, United States

Michelle Dias,

• Clary, Savannah Roberts, Fresenius Rx, Franklin, Tennessee, United States

Savannah Roberts Clary,

• Rondeau, Diane M, Fresenius Medical Care North America, Waltham, Massachusetts, United States

Diane M Rondeau,

• Reviriego-Mendoza, Marta, Fresenius Medical Care North America, Waltham, Massachusetts, United States

Marta Reviriego-Mendoza,

• Larkin, John W., Fresenius Medical Care North America, Waltham, Massachusetts, United States

John W. Larkin,

• Usvyat, Len A., Fresenius Medical Care North America, Waltham, Massachusetts, United States

Len A. Usvyat,

• Ketchersid, Terry L., Fresenius Medical Care North America, Waltham, Massachusetts, United States

Terry L. Ketchersid,

• Maddux, Franklin W., Fresenius Medical Care North America, Waltham, Massachusetts, United States

Franklin W. Maddux,

Background

Patients on dialysis are known to have a high medication burden, taking about 10 to 12 different medications. This burden has been associated with increased rates of medication non-adherence, especially for mineral bone disorder (MBD) therapies. It has been estimated that >50% of dialysis patients do not take their phosphate binders as prescribed (Ghimire et al. 2015). We aimed to characterize the outcomes of dialysis patients based on their MBD medication adherence levels.

Methods

In this retrospective cohort analysis, we included all patients dialyzed at Fresenius Kidney Care clinics between 2006 and 2016. Patients were characterized based on their MBD medication adherence levels per dietician assessment and categorized as: 1) “taking the medication as prescribed”, and 2) “taking the medication inconsistently or not at all.” The most recent MBD medication adherence assessment per patient was utilized for categorization. Rates of hospital admissions and mortality were calculated during the entire study period per patient basis.

Results

We analyzed data on 135,340 dialysis patients and identified that 9,929 (8%) took MBD medications inconsistently or not at all. Overall, we found lower rates of hospitalizations and mortality in patients who were determined to be adherent to their MBD medications versus those who were non-adherent. The hospitalization rate was 2.1 admissions per patient year (ppy) for the non-adherent group and 1.7 ppy for the patients taking MBD medication as prescribed (p<0.001 using Poisson regression). There were 9.3 deaths per 100 patient years (p100py) in the non-adherent group, and 8.8 p100py in the adherent group (p=0.0013 using a Kaplan Meier analysis).

Conclusion

In dialysis patients with bone disorders, MBD medication adherence appears to be associated with hospitalization and mortality outcomes. Importantly, these results are only reflective of patients with bone disorders and not the overall dialysis population. Further analyses are needed to understand root causes for dialysis patient medication non-adherence.

Funding

• Commercial Support –