By Susan Bray, MD, MBE, FACP

Patients with significant kidney disease usually require several medications to help keep their fluids and metabolic issues in good balance. The average number of pills taken by American dialysis patients is 19 every day, as well as some injectable drugs. Reducing the number of pills a patient needs to take per day has been associated with better adherence (compliance) with taking medications as prescribed. One study reports that 62 percent of dialysis patients are non-adherent with taking medications.

Why, you might ask, is it important to take "all those meds?" Well, there are many reasons, such as maintaining good health in general; controlling high blood pressure and thus preventing some of the consequences of hypertension, such as stroke and heart failure. Taking vitamin D and phosphate binders can ensure good bone and heart muscle health. ESAs (erythopoietin stimulating agents) help build and maintain good blood counts (hemoglobin), thus preventing the effects of severe anemia such as fatigue and shortness of breath. Vitamins also help on many levels. All of the above measures help protect patients from the high risk of cardiovascular disease and death that is so common in chronic kidney disease (CKD) patients. Unfortunately, studies show that younger people with kidney disease are the most non-adherent of the population of kidney patients, for a variety of different reasons.

Since we know that taking prescribed medication is very important, what are some of the barriers patients face taking them as directed? Not fully understanding why their physician prescribed certain medications and the medication's necessity to their well-being is one reason, as is concern about possible side effects of the medications. Also, the lack of feeling better right away may cause some patients to stop taking their prescribed meds, because they may feel the pills are simply "not working."

A very large problem in the United States is peoples' inability to afford prescriptions, thus leading to discontinuing them or taking them less often than prescribed. This practice does not allow the medications to have the desired healing effect.

Many patients also simply forget to take their medicines regularly. It is very important to know what drugs you are supposed to take and why. Another barriet to taking medication as prescribed is discontinuing medications, especially blood pressure drugs, once patients are feeling better. Another, very frustrating reason, for patients to stop taking medication is the patient's inability to open the "child proof" lids on the bottle of pills. This is a very real problem for individuals dealing with arthritis.

Clinical studies looking at the issue of non-adherence have revealed a number of clinical variables affecting why patients do not take medication as prescribed. These include the following:

• Length of time the patient has been on dialysis
• The presence of diabetes
• Previous transplantation
• Number of pills taken daily, especially phosphate binders
• Psychosocial variables, beliefs regarding taking medications, concerns about adverse side effects, presence of social support systems, family dynamics, some personality traits (low conscientiousness, high cynical hostility, lack of self-control)

What if a patient does not take medications as prescribed? Well, there are various consequences to that decision such as:

• Volume overload with its associated swelling and shortness of breath
• Increasing blood pressure and risks of stroke, heart attack, blood vessel stiffening and worsening kidney failure
• Bone disease with pain and possible fractures
• Metabolic disarray, including high potassium and high phosphate
• Neuropathy causing such disturbances as restless legs and very painful and/or numb feet
• Confusion and drowsiness as renal function worsens

Many people worry about developing side effects from some of their prescriptions; these are real concerns since many medications do have significant side effects. There are some helpful things that can be done to limit experiencing medication side effects:

• Keep a correct list of the names of the medicines that you are taking.
• Find out the medication's known side effects from your doctor or pharmacist. It is easy to manage a side effect when you know what to possibly expect.
• Tell someone (doctor, dialysis nurse, pharmacist) right away when you are experiencing an unpleasant side effect for instructions as to which prescription may be the offending drug and how to go about stopping it, changing the dose or changing to a different medication all together.
• Ask your doctor if it is possible to consolidate to fewer total pills or possibly take them fewer times per day.

In summary - patients with kidney disease typically cannot get away from having to take many pills a day, but each one has a specific purpose and needs to be taken as directed. Taking medications as prescribed can help patients look forward to feeling well and achieving a good quality of life.

The My Health Record section of the AAKP My Health website allows you to enter all your medications. You can record why each medication is used, the dosage required and what doctor prescribed the medication. For more information, visit www.aakp.org/my-health.

Susan Bray, MD, MBE, FACP is a Clinical Associate Professor of Drexel University and practicing nephrologist in Philadelphia, PA. Her areas of interest include patient education in CKD management, Self-Care in-center hemodialysis, all home therapies and hypertension management.

This article originally appeared in the September 2010 issue of aakpRENALIFE.

Posted 9/22/10.

Back