Is quality of life associated with compliance to pharmacoterapy in patients with chronic kidney disease undergoing maintenance hemodialysis?

Alves, Keila Batista; Guilarducci, Nathália Vital; Santos, Thiago dos Reis; Baldoni, André Oliveira; Otoni, Alba; Pinto, Sérgio Wyton Lima; Zanette, Camila; Sanches, Cristina

doi:10.1590/S1679-45082018AO4036

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Original Article • Einstein (São Paulo) 16 (1) • 2018 • https://doi.org/10.1590/S1679-45082018AO4036 copy

Is quality of life associated with compliance to pharmacoterapy in patients with chronic kidney disease undergoing maintenance hemodialysis?

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective

To analyzed the association of quality of life and compliance to drug treatment in chronic kidney disease patients.

Methods

The Short Form Health Survey was used to evaluate the quality of life of these patients, and the therapeutic complexity index was verified. The Morisky-Green test and the Brief Medication Questionnaire were applied to check compliance to drug therapy.

Results

A total of 197 patients were included. The Morisky-Green test and Brief Medication Questionnaire showed that most patients had low compliance to treatment (50.3% and 80.6%, respectively). Compliance was highly associated with gender (male) and slightly associated with complexity of therapy, mental health, and social aspects.

Conclusion

We observed a slight association between compliance to pharmacotherapy and quality of life and complexity of therapy, and a strong association with gender.

Keywords
Renal insufficiency, chronic; Medication adherence; Quality of life; Renal dialysis

Characteristics		n (%)
Male gender		121 (61.4)
Age, years
	25-48	54 (27.4)
	49-56	45 (22.8)
	57-66	53 (26.9)
	≥67	45 (22.8)
Ethnicity
	White	142 (72.1)
	Black	55 (27.9)
Marital status
	Married	108 (54.8)
	Single	57 (28.9)
	Widow/widowed	26 (13.2)
	Divorced	6 (3.0)
Retired
	Yes	142 (72.1)
	No	55 (27.9)
Schooling level
	Elementary school, incomplete	113 (57.3)
	Elementary school, complete	35 (17.8)
	High school, complete	32 (16.2)
	Further education	10 (5.1)
	Illiterate	5 (2.5)
	No answer	2 (1.0)

Domains	Total value	Women (n=76)	Men (n=121)	p value^* * Statistical test: Mann Whitney.
Physical functioning	60 (25-80)	47.5 (20-71.3)	70 (40-85)	0.002
Physical role functioning	0 (0-50)	0 (0-50)	25 (0-50)	0.071
Bodily pain	62 (22-100)	41 (22-100)	100 (30-100)	0.013
General health perceptions	55 (45-67)	52(40-62.8)	57 (50-67)	0.012
Vitality	65 (55-75)	60 (55-75)	65 (55-75)	0.033
Social role functioning	100 (62.5-100)	100 (62.5-100)	100 (62.5-100)	0.412
Emotional role functioning	33.3 (33.3-100)	33.3 (33.3-100)	33.3 (33.3-100)	0.766
Mental health	76 (60-92)	72 (56-89)	80 (74-96)	0.017

Domains	Compliance (n=99)	Non-compliance (n=98)	p value^* * Statistical test: Mann-Whitney.
Physical functioning	70 (0-100)	50 (5-100)	0.011
Physical role functioning	25 (0-100)	0 (0-100)	0.014
Bodily pain	100 (0-125)	31.50 (0-100)	<0.001
General health perceptions	62 (20-134)	45 (20-80)	<0.001
Vitality	70 (25-375)	55 (15-325)	<0.001
Social role functioning	100 (25-100)	62.5 (13-113)	<0.001
Emotional role functioning	33.33 (0-100)	33.33 (0-100)	0.501
Mental health	88 (20-100)	60 (8-100)	<0.001

SF-36 domains	BMQ score =0 (compliance)	BMQ score ≥1 (non-compliance)	p value^* * Statistical test: Mann Whitney.
	BMQ – regimen domain
	n=5	n=192
Physical functioning	85 (70-90)	55 (25-80)	0.006
Physical role functioning	50 (25-75)	0 (0-50)	0.061
Bodily pain	100 (61-100)	61 (22-100)	0.134
General health perceptions	62 (60-70)	55 (45-67)	0.046
Vitality	75 65-75)	65 (55-75)	0.164
Social role functioning	75 (62.5-100)	100 (62.5-100)	0.862
Emotional role functioning	66.7 (33.3-100)	33.3 (33.3-100)	0.909
Mental health	76 (64-100)	76 (60-92)	0.449
	BMQ – belief domain
	n=172	n=25
Physical functioning	60 (25-55)	60 (20-80)	0.804
Physical role functioning	0 (0-50)	0 (0-25)	0.186
Bodily pain	72 (22-100)	32 (22-100)	0.055
General health perceptions	55 (45-67)	52 (40-60)	0.082
Vitality	65 (55-75)	55 (45-75)	0.035
Social role functioning	100 (62.5-100)	62.5 (62.5-100)	0.004
Emotional role functioning	33.3 (33.3-100)	33.3 (0-66.7)	0.105
Mental health	80 (64-96)	56 (44-72)	<0.0001
	BMQ – memory domain
	n=7	n=190
Physical functioning	45 (32.5-68.8)	60 (25-80)	0.330
Physical role functioning	0 (0-37.5)	0 (0-50)	0.466
Bodily pain	100 (71.5-100)	61 (22-100)	0.332
General health perceptions	62.5 (54-66.5)	55 (45-67)	0.590
Vitality	67.5 (56.3-75)	65 55-75)	0.894
Social role functioning	81.3 (62.5-100)	100 (62.5-100)	0.777
Emotional role functioning	100 (25-100)	33.3 (33.3-100)	0.843
Mental health	68 (60-82)	76 (60-92)	0.391
Saúde mental	68 (60-82)	76 (60-92)	0,391

Categories		p value^* * χ2 test. OR: odds ratio; 95%CI: 95% of confidence interval; MGT: Morisky-Green test; TCI: therapeutic complexity index; BMQ: Brief Medication Questionnaire.	OR	95%CI
MGT compliant
	General health perceptions	0.011	1.026	1.006-1.047
	Mental health	0.001	1.026	1.011-1.041
	TCI	0.019	1.053	1.008-1.101
BMQ regimen
	TCI	0.004	0.856	0.771-0.952
	Age	0.005	0.934	0.891-0.980
BMQ beliefs
	Social role functioning	0.014	1.021	1.004-1.038
	Mental health	0.004	1.029	1.009-1.049
BMQ recall
Gender
	Female	-	1.00	-
	Male	0.047	9.354	1.027-85.232
TCI		0.004	0.524	0.337- 0.816

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[1] Corresponding author: Cristina Sanches, Universidade Federal de São João del- Rei, Campus Centro Oeste – Rua Sebastião, Gonçalves Coelho, 400 Chanadour Zip code: 35501-296 - Divinópolis, MG, Brazil, Phone: (55 37) 3221-1164 E-mail: csanches@ufsj.edu.br