Pediatric Nephrology

, Volume 34, Issue 1, pp 97–105 | Cite as

Does a multimethod approach improve identification of medication nonadherence in adolescents with chronic kidney disease?

  • Cozumel S. PruetteEmail author
  • Shayna S. Coburn
  • Cyd K. Eaton
  • Tammy M. Brady
  • Shamir Tuchman
  • Susan Mendley
  • Barbara A. Fivush
  • Michelle N. Eakin
  • Kristin A. Riekert
Original Article



Medical provider assessment of nonadherence is known to be inaccurate. Researchers have suggested using a multimethod assessment approach; however, no study has demonstrated how to integrate different measures to improve accuracy. This study aimed to determine if using additional measures improves the accurate identification of nonadherence beyond provider assessment alone.


Eighty-seven adolescents and young adults (AYAs), age 11–19 years, with chronic kidney disease (CKD) [stage 1–5/end-stage renal disease (ESRD)] and prescribed antihypertensive medication, their caregivers, and 17 medical providers participated in the multisite study. Five adherence measures were obtained: provider report, AYA report, caregiver report, electronic medication monitoring (MEMS), and pharmacy refill data [medication possession ratio (MPR)]. Concordance was calculated using kappa statistic. Sensitivity, specificity, positive predictive power, and negative predictive power were calculated using MEMS as the criterion for measuring adherence.


There was poor to fair concordance (kappas = 0.12–0.54), with 35–61% of AYAs classified as nonadherent depending on the measure. While both providers and MEMS classified 35% of the AYAs as nonadherent, sensitivity (0.57) and specificity (0.77) demonstrated poor agreement between the two measures on identifying which AYAs were nonadherent. Combining provider report of nonadherence and MPR < 75% resulted in the highest sensitivity for identifying nonadherence (0.90) and negative predictive power (0.88).


Nonadherence is prevalent in AYAs with CKD. Providers inaccurately identify nonadherence, leading to missed opportunities to intervene. Our study demonstrates the benefit to utilizing a multimethod approach to identify nonadherence in patients with chronic disease, an essential first step to reduce nonadherence.


Antihypertensive Adherence Measures Pediatric Provider perception Concordance 



This study was supported by the National Institute of Diabetes and Digestive and Kidney Disease award (R01DK092919 to KAR). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Compliance with ethical standards

Caregivers and AYAs ≥ 18 years old provided informed consent, and AYAs < 18 years old gave assent to join a 2-year longitudinal study to assess antihypertensive medication adherence.

The Institutional Review Boards at all three institutions approved the study.

Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© IPNA 2018

Authors and Affiliations

  • Cozumel S. Pruette
    • 1
    Email author
  • Shayna S. Coburn
    • 2
  • Cyd K. Eaton
    • 3
  • Tammy M. Brady
    • 1
  • Shamir Tuchman
    • 4
  • Susan Mendley
    • 5
  • Barbara A. Fivush
    • 1
  • Michelle N. Eakin
    • 3
  • Kristin A. Riekert
    • 3
  1. 1.PediatricsJohns Hopkins UniversityBaltimoreUSA
  2. 2.Psychiatry & Behavioral SciencesGeorge Washington School of MedicineWashingtonUSA
  3. 3.MedicineJohns Hopkins UniversityBaltimoreUSA
  4. 4.NephrologyChildren’s National Health SystemWashingtonUSA
  5. 5.Kidney, Urologic, and Hematologic DiseasesNational Institutes of HealthWashingtonUSA

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