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Saudi Journal of Kidney Diseases and Transplantation
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Table of Contents   
LETTER TO THE EDITOR  
Year : 2019  |  Volume : 30  |  Issue : 2  |  Page : 554-556
Daily pill burden and pill burden from phosphate binders in Japanese dialysis patients: Single center study


Department of Internal Medicine, Division of Nephrology and Hypertension, St. Marianna University School of Medicine, Kawasaki, Japan

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Date of Submission08-Jul-2018
Date of Acceptance08-Sep-2018
Date of Web Publication23-Apr-2019
 

How to cite this article:
Imai N, Osako K, Kaneshiro N, Shibagaki Y. Daily pill burden and pill burden from phosphate binders in Japanese dialysis patients: Single center study. Saudi J Kidney Dis Transpl 2019;30:554-6

How to cite this URL:
Imai N, Osako K, Kaneshiro N, Shibagaki Y. Daily pill burden and pill burden from phosphate binders in Japanese dialysis patients: Single center study. Saudi J Kidney Dis Transpl [serial online] 2019 [cited 2019 May 20];30:554-6. Available from: http://www.sjkdt.org/text.asp?2019/30/2/554/256869


To the Editor,

Dialysis patients, whether hemodialysis (HD) or peritoneal dialysis (PD), are reported to have a high pill burden due to complex chronic illness often associated with multiple comorbidities. There are currently little published data on daily pill burden and pill burden from phosphate binders in dialysis patients.[1] The previous study has reported that the daily pill burden of HD patients was 19 and phosphate binders contributed to 49% of the daily pill burden.[2] Furthermore, only a few studies have reported the contribution of different classes of drugs to the daily pill burden in dialysis patients.[1],[2] This cross-sectional study was undertaken to investigate the impact of dialysis modality on daily pill burden and pill burden from phosphate binders.

Sixty dialysis patients were studied. The key characteristics of the patients are summarized in [Table 1]. The mean age of the HD patients was 67.2 years and that of the PD patients was 65.1 years (P = 0.505). Dialysis vintage of the HD patients was 85.1 months and that of the PD patients was 23.4 months (P <0.001). The mean daily medication number was 11.4 in HD patients and 8.8 in PD patients. The mean daily pill burden was 24.7 in HD patients and was 17.4 in PD patients [Table 2]. The mean pill burden from phosphate binders were 10.1 in HD patients and were 5.1 in PD patients. In HD patients, phosphate binders were the single largest, and anti-hypertensives were the second largest contributor followed by gastrointestinal agents. They accounted for 40.9%, 16.2%, and 9.7% of the total pill burden, respectively [Figure 1]. In HD patients, there were 32 patients (70%) taking more than one kind of phosphate binders. Thirty-two patients were taking calcium carbonate, and 30 patients were taking lanthanum carbonate. On the other hand, in PD patients, anti-hypertensives were the single largest and phosphate binders were the second largest contributor followed by endocrine/hormonal agents. They accounted for 36.8%, 29.3%, and 12.1% of the total pill burden, respectively [Figure 2].
Table 1: Patients characteristics.

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Table 2: Daily medication number and daily pill burden.

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Figure 1: Daily pill burden in hemodialysis patients.

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Figure 2: Daily pill burden in peritoneal dialysis patients.

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This study confirmed that daily pill burden of dialysis patients is also high in Japanese dialysis patients. The results were similar to what has been reported in non-Japanese patients.[3] The daily pill burden of dialysis patients is reported to be significantly higher than that of patients with other chronic diseases such as diabetes mellitus and congestive heart failure.[2],[4],[5] Although medication adherence was not assessed in this study, medication adherence is reported to be around 50% in the general and dialysis population.[2] Large pill burden can reduce adherence and thus, it can lead to further pill burden to achieve medication goals in dialysis patients. Medication adherence, clinical outcome, overall treatment cost-effectiveness, and quality of life must be taken into account whenever prescribing medications to dialysis patients.

Conflict of interest: None declared.



 
   References Top

1.
Parker K, Nikam M, Jayanti A, Mitra S. Medication burden in CKD-5D: Impact of dialysis modality and setting. Clin Kidney J 2014;7:557-61.  Back to cited text no. 1
    
2.
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.  Back to cited text no. 2
    
3.
Manley HJ, Garvin CG, Drayer DK, et al. Medication prescribing patterns in ambulatory haemodialysis patients: Comparisons of USRDS to a large not-for-profit dialysis provider. Nephrol Dial Transplant 2004;19:1842-8.  Back to cited text no. 3
    
4.
Vanderpoel DR, Hussein MA, Watson-Heidari T, Perry A. Adherence to a fixed-dose combination of rosiglitazone maleate/metformin hydrochloride in subjects with type 2 diabetes mellitus: A retrospective database analysis. Clin Ther 2004;26:2066-75.  Back to cited text no. 4
    
5.
Frishman WH. Importance of medication adherence in cardiovascular disease and the value of once-daily treatment regimens. Cardiol Rev 2007;15:257-63.  Back to cited text no. 5
    

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Correspondence Address:
Naohiko Imai
Department of Internal Medicine, Division of Nephrology and Hypertension, St. Marianna University School of Medicine, Kawasaki
Japan
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DOI: 10.4103/1319-2442.256869

PMID: 31031398

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    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1], [Table 2]



 

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