Abstract
Background
Phosphate control is a crucial treatment goal in end-stage renal disease, but poor patient adherence to phosphate binder therapy remains a challenge. This study aimed to estimate the extent of phosphate binder adherence in hemodialysis patients and to identify potential determinants.
Methods
Phosphate binder adherence was measured blindly in 135 hemodialysis patients for 2 months using the medication event monitoring system. Patient data, gathered at inclusion through medical records, ad hoc questionnaires and the short form (SF)-36 health survey, included: (1) demographics, (2) perceived side-effects, belief in benefit, self-reported adherence to the therapy, (3) knowledge about phosphate binder therapy, (4) social support, and (5) quality of life (SF-36). Phosphatemia data was collected from charts. ‘Being adherent’ was defined as missing <1 total daily dose/week and ‘being totally adherent’ as missing <1 total daily dose/week, every week.
Results
Mean age of patients was 67 years and 64 % of the sample was male. Over the 2 months, 78 % of the prescribed doses were taken. Every week, about half of patients were adherent. Over the entire 8-week period, 22 % of patients were totally adherent. Mean phosphatemia levels were 0.55 mg/dl lower in adherent than nonadherent patients (4.76 vs. 5.31 mg/dl). Determinants for being totally adherent were living with a partner, higher social support (both were interrelated) and higher physical quality of life. Experiencing intake-related inconvenience negatively affected adherence. The social support and quality of life physical score explained 26 % of the variance in adherence.
Conclusions
Phosphate binder nonadherence remains a major problem. Interventions should aim, at least, to improve social support. With few associated factors found and yet low adherence, an individualized approach seems indicated.
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Acknowledgments
Sincere thanks to Vocatio vzw for acknowledging and supporting the curriculum of Yoleen Van Camp. We greatly appreciate the professional and technical support by MWV Healthcare® and the cooperation of all the participating patients. Many thanks for the efforts of the local study nurses, assisting master students and nephrologists Paul Arnouts, Koen Bouman, Ronald Daelemans, Katja De Grande, Elfie Deprez, Wendy Engelen, Heidi Hoeben, Ann Scheipers, Leen Torremans, Daniël Van Caesbroeck, Ludo Van Doorslaer, Sarina Van Loock, Jeannine Van Loon, Bob Van Santbergen and Sandra Vervynckt.
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Van Camp, Y.P.M., Vrijens, B., Abraham, I. et al. Adherence to phosphate binders in hemodialysis patients: prevalence and determinants. J Nephrol 27, 673–679 (2014). https://doi.org/10.1007/s40620-014-0062-3
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DOI: https://doi.org/10.1007/s40620-014-0062-3