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Assessment of knowledge and adherence to therapy among chronic kidney disease patients attending nephrology department of tertiary care hospital, Kurnool city, Andhra Pradesh

T Siva Kala, Arepalli Sreedevi, M V Hari Prasad, P N Jikki.

Background: High level of adherence to prescribed medication is very essential to obtain the desired outcomes in chronic kidney disease (CKD) patients. Non-adherence to medication has been associated with increased morbidity, mortality, and higher costs of care.

Objectives: The objectives of this study were as follows: (1) To assess adherence to medications in CKD patients, (2) to know the patient’s knowledge regarding treatment, and (3) to study factors associated with nonadherence to medications in CKD patients.

Materials and Methods: A cross-sectional study was conducted in the nephrology department of a tertiary care hospital. Patients (n = 206) aged >18 years, diagnosed with CKD and on treatment for >3 months were interviewed. Permission from ethical committee was taken and informed consent was obtained from the study subjects before start of the study. Morisky Medication Adherence Questionnaire (MMAQ) was used to assess overall adherence. A high score indicates poor adherence.

Results: Of 206 patients, 1.46% (3) were Stage 1, 2.91% (6) were Stage 2, 11.17% (23) were Stage 3, 15.53% (32) were Stage 4, and 68.93% (142) were Stage 5 of CKD according to the National Kidney Foundation 2002 guidelines. Using the MMAQ, high, medium, and low adherence was reported in 23.30%, 42.23%, and 34.47% of patients, respectively. An average number of medicines taken in a day by each patient was 5.75 ± 0.707. Common causes of non-adherence were forgetfulness (71.51%), high cost of medicine (24.05%), and large pill burden (18.35%).

Conclusions: Non-adherence remains a major obstacle in the effective management of CKD population. Periodic counseling about the importance of medication adherence to the patients and caregivers is essential to improve adherence.

Key words: Chronic Kidney Disease; Treatment Adherence, Morisky Medication Adherence Questionnaire; Score; Non-adherence

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