The association of medication regimen complexity on patient-related and clinical outcomes in end stage kidney disease

Abstract

Background: End stage kidney disease (ESKD) is the most severe form of chronic kidney disease (CKD), with increasing prevalence worldwide. Advances in ESKD treatment and pharmacotherapy have improved survival rates, but polypharmacy is inevitable due to multiple medications needed for comorbid conditions.

Research gap: The impact of medication regimen complexity and burden on health outcomes in chronic diseases is known, but little is understood across different dialysis modalities, particularly beyond haemodialysis (HD).

Aims & objectives: This thesis aims to quantify and compare medication regimen complexity in patients across different dialysis modalities (facility-based HD, home HD, peritoneal dialysis (PD)), and explores associations with patient-centred and clinical outcomes.

Methods: Three studies were conducted:

• Study 1: Literature review of assessment methods, outcomes related to medication complexity, and effectiveness of interventions to address the complexity in ESKD.

• Study 2: Prospective study with retrospective component quantifying medication complexity and comparing the outcomes in 145 facility-based and home-based HD patients.

• Study 3: Similar study design for 131 PD patients, examining regimen complexity and outcomes.

Key findings:

• Study 1: Adverse health outcomes, including poor quality of life (QoL), are linked to regimen complexity in dialysis-dependent and kidney transplant patients.

• Study 2: Higher medication complexity in home HD patients, but better QoL and hospitalisation outcomes compared to facility-based HD patients.

• Study 3: PD patients adhering to medications had better QoL and serum phosphate levels than non-adherent patients.

Conclusion: These studies enhance understanding of medication regimen complexity and its association on outcomes across different dialysis modalities. The findings provide a basis for future multicentre studies to develop interventions to reduce medication complexity and improve outcomes in ESKD.