Saudi Journal of Kidney Diseases and Transplantation

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


Naohiko Imai, Kiyomi Osako, Nagayuki Kaneshiro, Yugo Shibagaki 
 Department of Internal Medicine, Division of Nephrology and Hypertension, St. Marianna University School of Medicine, Kawasaki, Japan

Correspondence Address:
Naohiko Imai
Department of Internal Medicine, Division of Nephrology and Hypertension, St. Marianna University School of Medicine, Kawasaki
Japan




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;30:554-556


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 Sep 22 ];30:554-556
Available from: http://www.sjkdt.org/text.asp?2019/30/2/554/256869


Full Text



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}{Table 2}{Figure 1}{Figure 2}

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

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