Professor and Head of Department Qatar University College of Pharmacy Doha, Qatar
Background: Chronic kidney disease (CKD) is associated with multimorbidity and other health complications. Therefore, patients consume more medications, which leads to increased treatment-burden and adverse health and economic outcomes. Pill-burden is one component of the overall treatment-burden. However, little is known about the magnitude pill-burden and its contribution to the overall treatment-burden among patients with advanced CKD.
Objectives: To quantify the magnitude of pill-burden and its impact on treatment-burden among patients with advanced stages of CKD in Qatar.
Methods: A cross-sectional study was conducted among pre-dialysis and hemodialysis (HD) patients at Fahad Bin Jassim Kidney Center (FBJKC) in Qatar. Pill-burden was quantified as number of pills/patient/week using patients’ data from the electronic medical records. This was correlated to treatment-burden that was assessed using the Treatment Burden Questionnaire (TBQ). Statistical analysis was performed using SPSS-V24®.
Results: The median (IQR) number of prescribed chronic medications was 12 (5.7) oral medications and 3 (2) parenteral medications. The median (IQR) pill-burden for the study cohort was 112 (55) pills/week. HD patients experienced higher pill-burden than pre-dialysis patients [122 (61) vs. 109 (33) pills/week]. The most commonly prescribed oral medications were vitamin D (90.4%), sevelamer carbonate (65%), calcium (as a phosphate-binder or supplement) (63.2%), cinacalcet (67.5%), and statins (67.1%). There was a direct association between pill-burden and treatment-burden; patients who had higher pill-burden (117–239 pills/week) had significantly higher perceived treatment burden compared to lower pill-burden patients (22–116 pills/week) [47 (36.2) vs. 38.5 (36.7); p=0.0085]. Additionally, patients who were prescribed more than 12 oral medications/day perceived significantly higher treatment-burden compared to their counterparts who were prescribed 4–12 oral medications [47 (37) vs. 36 (35.5); p=0.006]. Similarly, patients who received higher parenteral medications (4–7) experienced significantly higher treatment-burden compared to lower parenteral medication consumers (less than 4) [50.5 (38.7) vs. 36.5 (32.5); p < 0.001].
Conclusions: Patients with advanced CKD experience a high pill-burden, which was directly associated with increased treatment-burden. Future intervention studies should target this population with an aim to reduce polypharmacy, pill-burden, treatment burden, which may ultimately improve CKD patients’ quality of life.
