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Medication-related problems common in chronic kidney disease

Many patients with chronic kidney disease do not fully comprehend the disease, which increases their risk for medication-related problems, such as poor medication adherence.

Thus, clinicians should incorporate methods to improve adherence in early disease state education, according to a commentary published in Health Literacy Research and Practice.

“Over one-half of patients with CKD have significant comorbid conditions,” Genevra Galura, BS, and Amy Barton Pai, PharmD, both from the University of Michigan College of Pharmacy, wrote. “Awareness of CKD and its consequences is poor, even in patients with a diagnosis of CKD. Less than 10% of survey participants with stage 1 to 3 CKD between 2001 and 2012 were aware that they had the disease. When compared to hypertension or diabetes, awareness of CKD is much lower.”

Medication-related problems, including nonadherence, use of drugs without documented indication, improper drug selection or dosing and inappropriate laboratory monitoring, frequently occur in patients with CKD and present a great cost burden, according to Galura and Pai. Patients with CKD often have risk factors for these medication-related problems, such as older age, at least three concurrent disease states, higher number of medications, greater frequency of dosing and medications that require frequent monitoring, the authors wrote.

Addressing health literacy is essential to enhance CKD awareness and medication adherence, as studies have found that poorer health outcomes, such as increased use of emergency services, hospitalizations and all-cause mortality, are linked to lower literacy, according to Galura and Pai. Patients with end-stage renal disease who have low health literacy are more likely to have lower kidney disease knowledge and higher mortality rates, the authors noted. However, the association between health literacy and medication adherence in patients with CKD is unknown due to lack of research, they wrote.

“There are continued challenges to improving medication literacy and adherence, including the many steps required to educate patients on using medications correctly,” Galura and Pai wrote. “Six steps have been proposed: fill, understand, organize, take, monitor and sustain. Patients who appropriately self-manage their medications must successfully complete each of these steps.”

For some patients, there are one or more barriers to completing each step, and potential interventions may be necessary, according to Galura and Pai.

Developing innovative and multimodal education initiatives, such as apps, are important in improving medication adherence in CKD, they wrote. Altering prescription drug labeling by simplifying language, improving typography and standardizing symbols can also improve adherence and outcomes, they wrote. Galura and Pai noted that patient-centered labels with explicit instructions improved medication adherence in patients with lower health literacy, but not in the general population. There is a paucity of quality, usable resources for clinicians to offer their patients with CKD that provide sufficient information to help them self-manage their disease because these materials are often written about the average patients’ literacy level, they wrote.

Absence of symptoms, delayed discussions with health care providers and thoughts that interventions cannot change the progression of CKD, may negatively impact a patient’s understanding of their diagnosis, according to Galura and Pai.

“CKD is a major health epidemic in the U.S.,” Galura and Pai concluded. “High costs for CKD patients result, in part, from patient’s low health literacy and poor medication adherence. There are many missed opportunities for health care providers to improve patient education. These include creating more user-friendly medication information materials and encouraging use of existing, underutilized apps to support understanding and adherence to medications.” – by Alaina Tedesco

Disclosure: Pai reports receiving a grant from the FDA.