Study: Patients on dialysis report medication as ‘a necessary evil’
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Key takeaways:
- Patients on dialysis said polypharmacy is a burden, but not as burdensome as dialysis treatment.
- Patients reported feeling their nephrologist did not understand their concerns about their medication regimen.
Patients who are on dialysis consider polypharmacy as “a necessary evil,” even when they do not notice positive effects, according to results of a study published in Kidney Medicine.
Common complaints among patients included unpleasant sensations while taking their medication, negative adverse events and feeling like their nephrologist did not understand their concerns about their medication.
“Patients must contend with different burdensome aspects of medication, like logistical issues, side effects, and feelings of shame, dependency and internalized resistance, which can amount to significant discomfort,” Julia M.T. Colombijn, MSc, of University Medical Center Utrecht in the Netherlands, and colleagues wrote. “On the other hand, patients might also underrate the positive effects of medication on their quality of life as most medications do not relieve symptoms and rather than reverse the process, only slow the deterioration of their health.”
The prospective cohort study included interviews with 28 patients receiving dialysis treatment in Dutch and Belgian medical centers. Twenty patients were men, and eight were women. The average number of medications was about 10, and patients’ daily pill burden was about 14.
Nearly all patients reported medication as less burdensome than dialysis, and they viewed the medication as “a necessary evil.” Most patients did not notice positive effects from their medication, and only saw improvements in the form of lab results.
Patients who used to take more medications tended to have more positive views about their current regimen, according to results of the study. Patients who were taking more medications than they used to did not feel more negatively about their regimen compared with their own views of their previous regimen.
“Our study identified several opportunities to improve dialysis patients’ experience with medication,” the researchers wrote. “Nephrologists and patients together should evaluate the (negative) impact of medication on health and other aspects of patients’ lives continuously to make shared decisions about the most effective and least burdensome treatment. During discussions about medication with their patients, being aware that patients might have a different understanding of what ‘medication’ is can avoid misunderstandings. Pointing out the positive effects of medication that patients might not feel themselves can help to boost their motivation. Minor adjustments in type of medication or route of administration can help to mitigate the impact of medication on quality of life or even improve it.”
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