Relationship Between Medication Adherence To Calcium-free Phosphate Binders And Quality Of Life In Maintenance Hemodialysis Patients

Objective:To investigate the relationship between the medication adherence to calcium-free phosphate binders and the quality of life in maintenance hemodialysis patientsMethods:1.Two hundred and twenty-three patients of the department of kidney disease and blood purification of the second hospital of Tianjin medical university from March 2019 to September 2019 were collected.Inclusion criteria:age>18,patients who were received regular hemodialysis for≥3 months.Exclusion criteria:patients who cannot complete the kdqol-36 scale due to cognitive impairment,dementia;Patients who were unwilling or unable to complete the questionnaire;a history of malignancy,and a life expectancy<6 months.2.General information was collected,including:age,gender,marital status,smoking status（nonsmokers included those who had never smoked before and those who had quit for more than six months）,dialysis access,dialysis times/week,dialysis age,charlson comorbidity index（CCI）,body mass index（BMI）,the calcium-free phosphate binders medications,and on the basis of blood purification standard operating procedures（standard operation procedure,SOP,2019 edition）clinical lab index,including:hemoglobin（Hb）,albumin（ALB）,blood calcium(Ca²⁺),blood phosphorus（P）,intact parathyroid hormone（i PTH）,serum total cholesterol（TC）,triglyceride（TG）,high-density lipoprotein cholesterol（HDL-c）,low-density lipoprotein cholesterol（LDL-c）.3.The serum phosphorus level of>5.5mg/d L was defined as hyperphosphatemia by reference to the kidney disease outcome quality Initiative（K/DOQI）guidelines.4.The Morisky Medication Compliance Scale（MMAS-8）consists of 8 items.According to the MMAS-8,the patients’calcium-free phosphate binders medication adherence was evaluated,and the patients were grouped according to the scores.The full score of the scale is 8 points,Highly adherent group were identified with the score of 8 on the scale,medium adherence group with a score of 6 to 6-7,and low adherence group with a score of<6.We adopted the Chinese translation of KDQOL-36 on the website of KDQOL working group.5.KDQOL-36 contains 5subscales:symptoms and problem of kidney disease（SPKD）subscale,effects of kidney disease（EKD）subscale,burden of kidney disease（BKD）subscale,SF-12physical component summary（PCS）subscale,SF-12:mental component summary（MCS）subscale.There is no total score on the KDQOL-36 scale.Scores of each subscale are calculated separately,ranging from 0 to 100 scores.A higher score indicates a better quality of life.The KDQOL-36 scale was scored by using the Excel scoring template on the website of rand corporation（www.rand.org/health/surveys＿tools/kdqol）.6.All statistical analysis were handled with Statistical Package for Social Sciences（SPSS）version 25.0.The categorical variable was expressed in percentage（%）,andχ²test was used for comparison between groups.The numerical data of normal distribution were expressed as mean±standard deviation,t test was used for comparative analysis;The non-normal data were represented by M（1/4,3/4）,and the mann-whitney U test was used for inter-group comparison.Logistic regression analysis was used to identify possible risk factors for hyperphosphatemia.Bilateral P<0.05 was considered statistically significant.Results:the mean serum phosphorus level of 223 MHD patients was 6.62±1.81mg/d L,and the prevalence rate of hyperphosphatemia patients was 57.8%（129patients）.Among all patients,54.3%（121）patients took lanthanum carbonate and45.7%（102）patients took sveram carbonate.The mean serum phosphorus concentration of patients with hyperphosphatemia was higher than that of patients in non-hyperphosphatemia（7.87±1.31 mg/d L vs.4.91±0.62 mg/d L）,and the difference was statistically significant（P<0.05）.According to MMAS-8,the patients were divided into three groups（high adherence group,medium adherence group and low adherence group）.The percentage of patients in high,medium and low adherence group was 24.2%,43.5%and 32.3%,respectively.KDQOL-36 score was further evaluated to patients in the three medication adherence groups（high adherence group,medium adherence group and low adherence group）.The results showed that the scores of patients in the low adherence group were relatively low（P<0.05）.Comparing the clinical datas among the three groups of high adherence,medium adherence,and low adherence,the results showed that:age,type of medical insurance,family income,distance from the hospital and MMAS-8 score were statistically significant compared between the three groups（P<0.05）.Further comparison of the relationship of quality of life between the different adherence groups showed that patients with low adherence to calcium-free phosphate binders had significantly lower scores on the KDQOL-36 subscales（excluding the BKD subscale）compared with patients in the middle and high adherence groups（P<0.05）.Conclusions:1.Patients with maintenance hemodialysis and hyperphosphatemia have poor medication adherence.2.The blood phosphorus level of maintenance hemodialysis patients is related to the quality of life of KDQOL-36.The KDQOL-36quality of life score in the hyperphosphatemia group is low,suggesting that as the blood phosphorus level of maintenance hemodialysis patients increases,the quality of life of patients decreases trend.3.MHD patients with calcium-free phosphate binders had poor medication adherence.Issues related to age,monthly per capita income,type of medical insurance,and distance from the hospital was influencing factors for patient adherence with calcium-free phosphate binders.4.MHD patients’calcium-free phosphate binders medication adherence affected the quality of life of patients,and patients with high drug compliance had better quality of life.