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Saudi Journal of Kidney Diseases and Transplantation
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Table of Contents   
LETTER TO THE EDITOR  
Year : 2014  |  Volume : 25  |  Issue : 5  |  Page : 1078-1080
Improving medication adherence among adult patients on hemodialysis


Department of Nephrology, Kanoo Kidney Center, Dammam Medical Complex, P. O. Box 11825, Dammam 31463, Saudi Arabia

Click here for correspondence address and email

Date of Web Publication2-Sep-2014
 

How to cite this article:
Karkar A. Improving medication adherence among adult patients on hemodialysis. Saudi J Kidney Dis Transpl 2014;25:1078-80

How to cite this URL:
Karkar A. Improving medication adherence among adult patients on hemodialysis. Saudi J Kidney Dis Transpl [serial online] 2014 [cited 2019 Nov 16];25:1078-80. Available from: http://www.sjkdt.org/text.asp?2014/25/5/1078/139945
To the Editor,

I have very much enjoyed reading the article titled "Medication adherence among adult patients on hemodialysis" by Alkatheri et al, which has been published in the Saudi J Kidney Dis Transpl 2014;25(4):762-768.

As clarified in the introduction of this article, there are different factors that may contribute to the lack of medication adherence among adult patients on hemodialysis (HD). However, the number of medications, which is on average 19 pills to be taken on a daily basis by a HD patient, remains the main reason why many HD patients fail to adhere to their prescribed medications. Accordingly, there are, in my view, a number of suggested solutions that may help in improving medication adherence of HD patients as follows:

  1. Establishment and/or activation or increa­sing the education sessions of patients on HD treatment.
  2. Education about their chronic kidney di­sease, HD treatment and associated complications.
  3. Education and explanation of why these medications are important and why is it important that they are required to be taken regularly. This should also include clarifi­cation regarding the type, number, time of intake, storage and the value of these medications and their possible side-effects.
  4. Direct, frequent and regular contact of the concerned renal physician with HD patients, particularly during HD sessions (as some patients do not like or cannot attend the HD clinic follow-up appointments) may help in improving compliance.
  5. The value of the presence of a clinical pharmacist during HD rounds for better clarification of any misunderstandings about prescribed medications.
  6. It is of great help to hand over to the HD patients their prescribed medications before the end of their HD session (preferably by the clinical pharmacist). This is to ensure proper and adequate explanation by reviewing all prescribed medications one-by-one, especially if some medications are changed or doses are altered. This should also ensure adequate prescription coverage and receiving prescribed medications in case of transportation difficulties.
  7. The use of specialized medicine containers, with proper labeling of days of the week in letters and colors, may help patients remember and adhere regularly to their prescribed medications.
  8. Regular psychological monitoring of HD patients together with the support of the social worker. This regular attention would help in avoiding any sudden discontinuation of medications due to any encountered psychological or social problem. Further­more, social support may help to over­come the possible cost issue of medications.
  9. The role of the renal dietician cannot be overlooked, especially in helping HD patients in controlling diet and fluid intake. This would help, for example, in possible reduction in the prescribed doses of phosphorus binders and antihypertensive medications.
  10. Ensuring adequate dialysis, by educating patients about the importance of sticking to a minimum of 4 h of HD sessions three times per week, will not only reduce morbidity and mortality rates (especially cardiovascular morbidities with the extra burden of related medications) but also help in controlling fluid status with less-needed antihypertensive medications, for example. Furthermore, prescription of high-flux hemodialysis and/or hemodiafiltration treatment would ensure better clearance of uremic toxins including beta 2-micro-globulin and phosphorus, and better control of body fluids, all of which would help in reducing or avoiding certain medications like non-steroidal anti-inflammatory drugs, phosphorus binders and antihypertensive medications.
  11. Strict implementation of infection control policies and procedures in HD units can greatly help in avoiding exposure of HD patients to infection and the consequent need of increasing burden by prescription of more medications.
  12. Consideration of arteriovenous fistula as a first vascular access choice and avoidance, when possible, of central catheters can help in avoiding catheter-related local and systemic infections and the need of further medications of antibiotics.
  13. Research into more effective and specific medications that might help in reducing the quantity and frequency of intake of prescribed medications are much needed in improving compliance.


More specific research studies, however, are needed to examine practical ways to overcome difficulties and improve medication adherence in HD patients.

Conflict of interest:

None

Suggested Readings

  1. Chiu YW, Teitelbaum I, Misra M, de Leon EM, Adzize T, Mehrotra R. Pill burden, adherence, hyperphosphatemia, and quality of life in maintenance dialysis patients. Clin J Am Soc Nephrol 2009;4:1089-96.
  2. Karkar A. Caring for Patients with CRF: Rewards and Benefits. Int J Nephrol 2011; 2011:639840.
  3. Idier L, Untas A, Koleck M, Chauveau P, Rascle N. Assessment and effects of Therapeutic Patient Education for patients in hemodialysis: A systematic review. Int J Nurs Stud 2011;48: 1570-86.
  4. Holley JL, DeVore CC. Why all pres­cribed medications are not taken: Results from a survey of chronic dialysis patients. Adv Perit Dial 2006;22:162-6.
  5. Mirkov S. Implementation of a pharmacist medication review clinic for haemodialysis patients. N Z Med J 2009;122:25-37.
  6. St Peter WL, Wazny LD, Patel UD. New models of chronic kidney disease care including pharmacists: Improving medi­cation reconciliation and medication ma­nagement. Curr Opin Nephrol Hypertens 2013;22:656-62.
  7. Depp CA, Lebowitz BD, Patterson TL, Lacro JP, Jeste DV. Medication adherence skills training for middle-aged and elderly adults with bipolar disorder: Development and pilot study. Bipolar Disord 2007;6: 636-45.
  8. Conrad W, Sczupak C, Forman H, Gal P. Consultant approach to improving drug-related services to chronic hemodialysis patients. Am J Hosp Pharm 1978;35:558-61.
  9. Cupisti A, D'Alessandro C, Baldi R, Barsotti G. Dietary habits and counseling focused on phosphate intake in hemo-dialysis patients with hyperphosphatemia. J Ren Nutr 2004;14:220-5.
  10. Karkar A, Bouhaha BM, Dammang ML. Infection Control in Hemodialysis Units: A Quick Access to Essential Elements. Saudi J Kidney Dis Transpl 2014;25:496-519.
  11. Karkar A, Chaballout A, Ibrahim MH, Abdelrahman M, Al Shubaili M. Impro­ving arteriovenous fistula rate: Effect on hemodialysis quality. Hemodial Int 2014; 18:51621.
  12. Karkar A. Modalities of Hemodialysis: Quality Improvement. Saudi J Kidney Dis Transpl 2012;23:1145-61.


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Correspondence Address:
Ayman Karkar
Department of Nephrology, Kanoo Kidney Center, Dammam Medical Complex, P. O. Box 11825, Dammam 31463
Saudi Arabia
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DOI: 10.4103/1319-2442.139945

PMID: 25193913

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