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Differential Diagnoses and Clinical Implications of Medication Nonadherence in Older Patients with Chronic Kidney Disease: A Review

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Abstract

Older adults with chronic kidney disease (CKD) often have many comorbidities, which requires them to take multiple medications. As the number of daily medications prescribed increases, the risk for polypharmacy increases. Understanding and improving medication adherence in this patient population is vital to avoiding the drug-related adverse events of polypharmacy. The primary objective of this review is to summarize the existing literature and to understand the factors leading to medication nonadherence in older patients with CKD. In this review, we discuss the prevalence of polypharmacy, the current lack of consensus on the incidence of medication nonadherence, the heterogeneity of assessing medication adherence, and the most common differential diagnoses for medication nonadherence in this population. Specifically, the most common differential diagnoses for medication nonadherence in older adults with CKD are (1) medication complexity; (2) cognitive impairment; (3) low health literacy; and (4) systems-based barriers. We provide tailored strategies to address these differential diagnoses and subsequently improve medication adherence. The clinical implications include deprescribing to decrease medication complexity and polypharmacy, utilizing a team-based approach to identify and support patients with cognitive impairment, enriching communication between health providers and patients with low health literacy, and improving health care access to address systems-based barriers. Further research is needed to determine the effects of addressing these differential diagnoses and medication adherence in older adults with CKD.

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References

  1. Fast Stats. National chronic kidney disease fact sheet, 2017. US Department of Health and Human Services, Centers for Disease Control and Prevention; 2017.

  2. Stevens PE, Levin A. Evaluation and management of chronic kidney disease: synopsis of the kidney disease: improving global outcomes 2012 clinical practice guideline. Ann Intern Med. 2013;158(11):825–30. https://doi.org/10.7326/0003-4819-158-11-201306040-00007.

    Article  PubMed  Google Scholar 

  3. Nagar VR, Birthi P, Salles S, Sloan PA. Opioid use in chronic pain patients with chronic kidney disease: a systematic review. Pain Med. 2017;18(8):1416–49. https://doi.org/10.1093/pm/pnw238.

    Article  PubMed  Google Scholar 

  4. Triantafylidis LK, Hawley CE, Perry LP, Paik JM. The role of deprescribing in older adults with chronic kidney disease. Drugs Aging. 2018;35(11):973–84. https://doi.org/10.1007/s40266-018-0593-8.

    Article  PubMed  Google Scholar 

  5. Koronkowski MJ, Semla TP, Schmader KE, Hanlon JT. Recent literature update on medication risk in older adults, 2015–2016. J Am Geriatr Soc. 2017;65(7):1401–5. https://doi.org/10.1111/jgs.14887.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Secora A, Alexander GC, Ballew SH, Coresh J, Grams ME. Kidney function, polypharmacy, and potentially inappropriate medication use in a community-based cohort of older adults. Drugs Aging. 2018;35(8):735–50.

    Article  CAS  Google Scholar 

  7. Rifkin DE, Laws MB, Rao M, Balakrishnan VS, Sarnak MJ, Wilson IB. Medication adherence behavior and priorities among older adults with CKD: a semistructured interview study. Am J Kidney Dis. 2010;56(3):439–46. https://doi.org/10.1053/j.ajkd.2010.04.021.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Steinman MA, Miao Y, Boscardin WJ, Komaiko KD, Schwartz JB. Prescribing quality in older veterans: a multifocal approach. J Gen Intern Med. 2014;29(10):1379–86. https://doi.org/10.1007/s11606-014-2924-8.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Krishnaswami A, Steinman MA, Goyal P, Zullo AR, Anderson TS, Birtcher KK, et al. Deprescribing in older adults with cardiovascular disease. J Am Coll Cardiol. 2019;73(20):2584–95. https://doi.org/10.1016/j.jacc.2019.03.467.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Ho PM, Magid DJ, Shetterly SM, Olson KL, Maddox TM, Peterson PN, et al. Medication nonadherence is associated with a broad range of adverse outcomes in patients with coronary artery disease. Am Heart J. 2008;155(4):772–9. https://doi.org/10.1016/j.ahj.2007.12.011.

    Article  PubMed  Google Scholar 

  11. Granger BB, Swedberg K, Ekman I, Granger CB, Olofsson B, McMurray JJ, et al. Adherence to candesartan and placebo and outcomes in chronic heart failure in the CHARM programme: double-blind, randomised, controlled clinical trial. Lancet. 2005;366(9502):2005–111. https://doi.org/10.1016/s0140-6736(05)67760-4.

    Article  CAS  PubMed  Google Scholar 

  12. Krousel-Wood M, Holt E, Joyce C, Ruiz R, Dornelles A, Webber LS, et al. Differences in cardiovascular disease risk when antihypertensive medication adherence is assessed by pharmacy fill versus self-report: the Cohort Study of Medication Adherence among Older Adults (CoSMO). J Hypertens. 2015;33(2):412–20. https://doi.org/10.1097/hjh.0000000000000382.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Hawley CE, Triantafylidis LK, Paik JM. The missing piece: clinical pharmacists enhancing the interprofessional nephrology clinic model. J Am Pharm Assoc. 2019;59(5):727–35. https://doi.org/10.1016/j.japh.2019.05.010.

    Article  Google Scholar 

  14. Stemer G, Lemmens-Gruber R. The clinical pharmacist’s contributions within the multidisciplinary patient care team of an intern nephrology ward. Int J Clin Pharm. 2011;33(5):759–62. https://doi.org/10.1007/s11096-011-9548-4.

    Article  PubMed  Google Scholar 

  15. Whittaker CF, Miklich MA, Patel RS, Fink JC. Medication safety principles and practice in CKD. Clin J Am Soc Nephrol. 2018;13(11):1738–46. https://doi.org/10.2215/cjn.00580118.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Thompson S, James M, Wiebe N, Hemmelgarn B, Manns B, Klarenbach S, et al. Cause of death in patients with reduced kidney function. J Am Soc Nephrol. 2015;26(10):2504–11. https://doi.org/10.1681/asn.2014070714.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Rodriguez F, Maron DJ, Knowles JW, Virani SS, Lin S, Heidenreich PA. Association of statin adherence with mortality in patients with atherosclerotic cardiovascular disease. JAMA Cardiol. 2019;4(3):206–13. https://doi.org/10.1001/jamacardio.2018.4936.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Cedillo-Couvert EA, Ricardo AC, Chen J, Cohan J, Fischer MJ, Krousel-Wood M, et al. Self-reported medication adherence and CKD progression. Kidney Int Rep. 2018;3(3):645–51. https://doi.org/10.1016/j.ekir.2018.01.007.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Tangkiatkumjai M, Walker DM, Praditpornsilpa K, Boardman H. Association between medication adherence and clinical outcomes in patients with chronic kidney disease: a prospective cohort study. Clin Exp Nephrol. 2017;21(3):504–12. https://doi.org/10.1007/s10157-016-1312-6.

    Article  CAS  PubMed  Google Scholar 

  20. Krumpal I. Determinants of social desirability bias in sensitive surveys: a literature review. Qual Quant. 2013;47(4):2025–47.

    Article  Google Scholar 

  21. Rolley JX, Davidson PM, Dennison CR, Ong A, Everett B, Salamonson Y. Medication adherence self-report instruments: implications for practice and research. J Cardiovasc Nurs. 2008;23(6):497–505. https://doi.org/10.1097/01.Jcn.0000338931.96834.16.

    Article  PubMed  Google Scholar 

  22. Lehmann A, Aslani P, Ahmed R, Celio J, Gauchet A, Bedouch P, et al. Assessing medication adherence: options to consider. Int J Clin Pharm. 2014;36(1):55–69. https://doi.org/10.1007/s11096-013-9865-x.

    Article  PubMed  Google Scholar 

  23. Muntner P, Judd SE, Krousel-Wood M, McClellan WM, Safford MM. Low medication adherence and hypertension control among adults with CKD: data from the REGARDS (Reasons for Geographic and Racial Differences in Stroke) Study. Am J Kidney Dis. 2010;56(3):447–57. https://doi.org/10.1053/j.ajkd.2010.02.348.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Hsu KL, Fink JC, Ginsberg JS, Yoffe M, Zhan M, Fink W, et al. Self-reported Medication adherence and adverse patient safety events in CKD. Am J Kidney Dis. 2015;66(4):621–9. https://doi.org/10.1053/j.ajkd.2015.03.026.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Sontakke S, Budania R, Bajait C, Jaiswal K, Pimpalkhute S. Evaluation of adherence to therapy in patients of chronic kidney disease. Indian J Pharmacol. 2015;47(6):668–71. https://doi.org/10.4103/0253-7613.169597.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Parker K, Bull-Engelstad I, Aasebo W, von der Lippe N, Reier-Nilsen M, Os I, et al. Medication regimen complexity and medication adherence in elderly patients with chronic kidney disease. Hemodial Int. 2019;23(3):333–42. https://doi.org/10.1111/hdi.12739.

    Article  PubMed  Google Scholar 

  27. Hong K, Muntner P, Kronish I, Shilane D, Chang TI. Medication adherence and visit-to-visit variability of systolic blood pressure in African Americans with chronic kidney disease in the AASK trial. J Hum Hypertens. 2016;30(1):73–8. https://doi.org/10.1038/jhh.2015.26.

    Article  CAS  PubMed  Google Scholar 

  28. Ghimire S, Peterson GM, Castelino RL, Jose MD, Zaidi ST. Medication regimen complexity and adherence in haemodialysis patients: an exploratory study. Am J Nephrol. 2016;43(5):318–24. https://doi.org/10.1159/000446450.

    Article  CAS  PubMed  Google Scholar 

  29. Nguyen TM, La Caze A, Cottrell N. What are validated self-report adherence scales really measuring? A systematic review. Br J Clin Pharmacol. 2014;77(3):427–45. https://doi.org/10.1111/bcp.12194.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Morisky DE, Ang A, Krousel-Wood M, Ward HJ. Predictive validity of a medication adherence measure in an outpatient setting. J Clin Hypertens. 2008;10(5):348–54.

    Article  Google Scholar 

  31. Morisky DE, Green LW, Levine DM. Concurrent and predictive validity of a self-reported measure of medication adherence. Med Care. 1986;24(1):67–74.

    Article  CAS  Google Scholar 

  32. Wang SL, Chiu YW, Kung LF, Chen TH, Hsiao SM, Hsiao PN, et al. Patient assessment of chronic kidney disease self-care using the chronic kidney disease self-care scale in Taiwan. Nephrol (Carlton). 2019;24(6):615–21. https://doi.org/10.1111/nep.13475.

    Article  Google Scholar 

  33. Okeowo D, Patterson A, Boyd C, Reeve E, Gnjidic D, Todd A. Clinical practice guidelines for older people with multimorbidity and life-limiting illness: what are the implications for deprescribing? Therapeutic Adv Drug Saf. 2018;9(11):619–30.

    Article  Google Scholar 

  34. Ferreira JM, Galato D, Melo AC. Medication regimen complexity in adults and the elderly in a primary healthcare setting: determination of high and low complexities. Pharm Pract. 2015;13(4):659.

    Article  Google Scholar 

  35. George J, Phun Y-T, Bailey MJ, Kong DCM, Stewart K. Development and validation of the medication regimen complexity index. Ann Pharmacother. 2004;38(9):1369–76.

    Article  Google Scholar 

  36. Tesfaye WH, Peterson GM, Castelino RL, McKercher C, Jose MD, Wimmer BC, et al. Medication regimen complexity and hospital readmission in older adults with chronic kidney disease. Ann Pharmacother. 2018;53(1):28–34. https://doi.org/10.1177/1060028018793419.

    Article  PubMed  Google Scholar 

  37. Tesfaye WH, McKercher C, Peterson GM, Castelino RL, Jose M, Zaidi STR, et al. Medication adherence, burden and health-related quality of life in adults with predialysis chronic kidney disease: a prospective cohort study. Int J Environ Res Public Health. 2020;17(1):371.

    Article  Google Scholar 

  38. Petersen RC. Mild cognitive impairment clinical trials. Nat Rev Drug Discov. 2003;2(8):646–53.

    Article  CAS  Google Scholar 

  39. Osterberg L, Blaschke T. Adherence to medication. N Engl J Med. 2005;353(5):487–97. https://doi.org/10.1056/NEJMra050100.

    Article  CAS  PubMed  Google Scholar 

  40. Bronas UG, Puzantian H, Hannan M. Cognitive impairment in chronic kidney disease: vascular milieu and the potential therapeutic role of exercise. Biomed Res Int. 2017;2017:2726369. https://doi.org/10.1155/2017/2726369.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  41. Murray AM, Tupper DE, Knopman DS, Gilbertson DT, Pederson SL, Li S, et al. Cognitive impairment in hemodialysis patients is common. Neurology. 2006;67(2):216–23. https://doi.org/10.1212/01.wnl.0000225182.15532.40.

    Article  CAS  PubMed  Google Scholar 

  42. Ponticelli C, Sala G, Glassock RJ. Drug management in the elderly adult with chronic kidney disease: a review for the primary care physician. Mayo Clin Proc. 2015;90(5):633–45. https://doi.org/10.1016/j.mayocp.2015.01.016.

    Article  PubMed  Google Scholar 

  43. Drew DA, Weiner DE, Sarnak MJ. Cognitive impairment in CKD: pathophysiology, management, and prevention. Am J Kidney Dis. 2019;74(6):782–90. https://doi.org/10.1053/j.ajkd.2019.05.017.

    Article  CAS  PubMed  Google Scholar 

  44. Kurella M, Chertow GM, Fried LF, Cummings SR, Harris T, Simonsick E, et al. Chronic kidney disease and cognitive impairment in the elderly: the health, aging, and body composition study. J Am Soc Nephrol. 2005;16(7):2127–33. https://doi.org/10.1681/asn.2005010005.

    Article  PubMed  Google Scholar 

  45. Weiner DE, Seliger SL. Cognitive and physical function in chronic kidney disease. Curr Opin Nephrol Hypertens. 2014;23(3):291–7. https://doi.org/10.1097/01.mnh.0000444821.87873.7b.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Brown MT, Bussell J, Dutta S, Davis K, Strong S, Mathew S. Medication adherence: truth and consequences. Am J Med Sci. 2016;351(4):387–99. https://doi.org/10.1016/j.amjms.2016.01.010.

    Article  PubMed  Google Scholar 

  47. Taylor DM, Fraser SDS, Bradley JA, Bradley C, Draper H, Metcalfe W, et al. A systematic review of the prevalence and associations of limited health literacy in CKD. Clin J Am Soc Nephrol. 2017;12(7):1070–84.

    Article  Google Scholar 

  48. Taylor DM, Fraser S, Dudley C, Oniscu GC, Tomson C, Ravanan R, et al. Health literacy and patient outcomes in chronic kidney disease: a systematic review. Nephrol Dial Transplant. 2018;33(9):1545–58.

    PubMed  Google Scholar 

  49. Lauffenburger JC, Choudhry NK. A Call for a systems-thinking approach to medication adherence: stop blaming the patient. JAMA Internal Med. 2018;178(7):950–1.

    Article  Google Scholar 

  50. Mechta Nielsen T, Frojk Juhl M, Feldt-Rasmussen B, Thomsen T. Adherence to medication in patients with chronic kidney disease: a systematic review of qualitative research. Clin Kidney J. 2018;11(4):513–27. https://doi.org/10.1093/ckj/sfx140.

    Article  PubMed  Google Scholar 

  51. Goh H, Kwan YH, Seah Y, Low LL, Fong W, Thumboo J. A systematic review of the barriers affecting medication adherence in patients with rheumatic diseases. Rheumatol Int. 2017;37(10):1619–28. https://doi.org/10.1007/s00296-017-3763-9.

    Article  PubMed  Google Scholar 

  52. Schlanger LE, Bailey JL, Sands JM. Geriatric nephrology: old or new subspecialty. Clin Geriatr Med. 2009;25(3):311–24.

    Article  Google Scholar 

  53. Kurella Tamura M, Covinsky KE, Chertow GM, Yaffe K, Landefeld CS, McCulloch CE. Functional status of elderly adults before and after initiation of dialysis. N Engl J Med. 2009;361(16):1539–47.

    Article  Google Scholar 

  54. Ghimire S, Castelino RL, Jose MD, Zaidi STR. Medication adherence perspectives in haemodialysis patients: a qualitative study. BMC Nephrol. 2017;18(1):167.

    Article  Google Scholar 

  55. Yeam CT, Chia S, Tan HCC, Kwan YH, Fong W, Seng JJB. A systematic review of factors affecting medication adherence among patients with osteoporosis. Osteoporos Int. 2018;29(12):2623–37. https://doi.org/10.1007/s00198-018-4759-3.

    Article  CAS  PubMed  Google Scholar 

  56. Gnjidic D, Hilmer SN, Blyth FM, Naganathan V, Waite L, Seibel MJ, et al. Polypharmacy cutoff and outcomes: five or more medicines were used to identify community-dwelling older men at risk of different adverse outcomes. J Clin Epidemiol. 2012;65(9):989–95. https://doi.org/10.1016/j.jclinepi.2012.02.018.

    Article  PubMed  Google Scholar 

  57. McIntyre C, McQuillan R, Bell C, Battistella M. Targeted deprescribing in an outpatient hemodialysis unit: a quality improvement study to decrease polypharmacy. Am J Kidney Dis. 2017;70(5):611–8. https://doi.org/10.1053/j.ajkd.2017.02.374.

    Article  PubMed  Google Scholar 

  58. Parker K, Wong J. Is polypharmacy an increasing burden in chronic kidney disease? The German experience. Clin Kidney J. 2019;12(5):659–62. https://doi.org/10.1093/ckj/sfz072.

    Article  PubMed  PubMed Central  Google Scholar 

  59. Tesfaye WH, Wimmer BC, Peterson GM, Castelino RL, Jose M, McKercher C, et al. Effect of pharmacist-led medication review on medication appropriateness in older adults with chronic kidney disease. J Pharm Pract Res. 2019;49(5):471–6.

    Article  Google Scholar 

  60. Lauffenburger JC, Landon JE, Fischer MA. Effect of combination therapy on adherence among US patients initiating therapy for hypertension: a cohort study. J Gen Intern Med. 2017;32(6):619–25.

    Article  Google Scholar 

  61. Rakugi H, Ogihara T, Umemoto S, Matsuzaki M, Matsuoka H, Shimada K, et al. Combination therapy for hypertension in patients with CKD: a subanalysis of the combination therapy of hypertension to prevent cardiovascular events trial. Hypertens Res. 2013;36(11):947–58.

    Article  CAS  Google Scholar 

  62. Lin YC, Lai TS, Wu HY, Chou YH, Chiang WC, Lin SL, et al. Effects and safety of statin and ezetimibe combination therapy in patients with chronic kidney disease: a systematic review and meta-analysis. Clin Pharmacol Ther. 2020;108(4):833–43.

    Article  CAS  Google Scholar 

  63. Kröger E, Tatar O, Vedel I, Giguere AMC, Voyer P, Guillaumie L, et al. Improving medication adherence among community-dwelling seniors with cognitive impairment: a systematic review of interventions. Int J Clin Pharm. 2017;39(4):641–56.

    Article  Google Scholar 

  64. Fujita T, Notoya M, Kato K. The effectiveness of diverse technology-based instructions in assisting people with Alzheimer’s disease with medication management. Disabil Rehabil Assist Technol. 2020;15(5):528–36.

    Article  Google Scholar 

  65. Williams AF, Manias E, Walker R. Adherence to multiple, prescribed medications in diabetic kidney disease: a qualitative study of consumers' and health professionals' perspectives. Int J Nurs Stud. 2008;45(12):1742–56. https://doi.org/10.1016/j.ijnurstu.2008.07.002.

    Article  PubMed  Google Scholar 

  66. Lauffenburger JC, Khan NF, Brill G, Choudhry NK. Quantifying social reinforcement among family members on adherence to medications for chronic conditions: a US-based retrospective cohort study. J Gen Intern Med. 2019;34(6):855–61.

    Article  Google Scholar 

  67. Smith D, Lovell J, Weller C, Kennedy B, Winbolt M, Young C, et al. A systematic review of medication non-adherence in persons with dementia or cognitive impairment. PLoS ONE. 2017;12(2):e0170651.

    Article  Google Scholar 

  68. Muellers KA, Chen L, O’Conor R, Wolf MS, Federman AD, Wisnivesky JP. Health literacy and medication adherence in COPD patients: when caregiver presence is not sufficient. COPD: J Chronic Obstruct Pulmon Dis. 2019;16(5-6):362–7.

    Article  Google Scholar 

  69. Schillinger D, Piette J, Grumbach K, Wang F, Wilson C, Daher C, et al. Closing the loop: physician communication with diabetic patients who have low health literacy. Arch Intern Med. 2003;163(1):83–90. https://doi.org/10.1001/archinte.163.1.83.

    Article  PubMed  Google Scholar 

  70. Highlights of the 2017 U.S. PIAAC results web report (NCES 2020-777). U.S. Department of Education, Institute of Education Sciences, National Center for Education Statistics. https://nces.ed.gov/surveys/piaac/current_results.asp.

  71. Petty JL. Medication adherence and patient outcomes: part 2 Interventions and resources to overcome low health literacy. Clin Nurse Special. 2013;27(6):286–8.

    Article  Google Scholar 

  72. Ampofo AG, Khan E, Ibitoye MB. Understanding the role of educational interventions on medication adherence in hypertension: a systematic review and meta-analysis. Heart Lung. 2020;49(5):537–47.

    Article  Google Scholar 

  73. McCormack L, Thomas V, Lewis MA, Rudd R. Improving low health literacy and patient engagement: a social ecological approach. Patient Educ Couns. 2017;100(1):8–13.

    Article  Google Scholar 

  74. Monroe AK, Pena JS, Moore RD, Riekert KA, Eakin MN, Kripalani S, et al. Randomized controlled trial of a pictorial aid intervention for medication adherence among HIV-positive patients with comorbid diabetes or hypertension. AIDS Care. 2018;30(2):199–206.

    Article  CAS  Google Scholar 

  75. Patiag MC, Deveux S, Farrar MEH. Do errorless methods improve discharge medication instruction and adherence? Rehabil Nurs. 2019. https://doi.org/10.1097/rnj.0000000000000237.

    Article  PubMed  Google Scholar 

  76. Hawley CE, Triantafylidis LK, Phillips SC, Schwartz AW. Brown bag simulation to improve medication management in older adults. MedEdPORTAL. 2019;15:10857.

    Article  Google Scholar 

  77. Mishuk AU, Fasani I, Qian J. Impact of US federal and state generic drug policies on drug use, spending, and patient outcomes: a systematic review. Res Soc Administr Pharm. 2020;16(6):736–45.

    Article  Google Scholar 

  78. Kleinman NL, Schaneman JL, Lynch WD. The association of insulin medication possession ratio, use of insulin glargine, and health benefit costs in employees and spouses with type 2 diabetes. J Occup Environ Med. 2008;50(12):1386–93.

    Article  Google Scholar 

  79. Kang H, Lobo JM, Kim S, Sohn M-W. Cost-related medication non-adherence among US adults with diabetes. Diabetes Res Clin Pract. 2018;143:24–33.

    Article  Google Scholar 

  80. Capoccia K, Odegard PS, Letassy N. Medication adherence with diabetes medication: a systematic review of the literature. Diabetes Educator. 2016;42(1):34–71.

    Article  Google Scholar 

  81. Lewey J, Gagne JJ, Franklin J, Lauffenburger JC, Brill G, Choudhry NK. Impact of high deductible health plans on cardiovascular medication adherence and health disparities. Circul Cardiovasc Qual Outcomes. 2018;11(11):004632.

    Article  Google Scholar 

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Acknowledgements

The authors would like to thank Laura Triantafylidis, PharmD, BCGP, for her review of this manuscript.

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Authors and Affiliations

  1. New England Geriatric Research, Education and Clinical Center, VA Boston Healthcare System, 150 South Huntington Avenue, Boston, MA, 12D-94, USA

    Montgomery T. Owsiany, Chelsea E. Hawley & Julie M. Paik

  2. Renal Section, VA Boston Healthcare System, Boston, MA, USA

    Julie M. Paik

  3. Renal Division and Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA

    Julie M. Paik

  4. Harvard Medical School, Boston, MA, USA

    Julie M. Paik

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Montgomery T. Owsiany, Chelsea E. Hawley, and Julie M. Paik declare they have no conflicts of interest.

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Conceptualization: MTO and JMP. Literature search: MTO and CEH. Writing—original draft preparation: MTO. Writing—review and editing: MTO, CEH, and JMP.

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Owsiany, M.T., Hawley, C.E. & Paik, J.M. Differential Diagnoses and Clinical Implications of Medication Nonadherence in Older Patients with Chronic Kidney Disease: A Review. Drugs Aging 37, 875–884 (2020). https://doi.org/10.1007/s40266-020-00804-8

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