Assessment of Medications Adherence among Patients of Kidney Dialysis in an Iraqi Cohort in Erbil City

Abstract

Background: Adherence to prescribed medications is an important aspect of effective treatment management for patients with ESRD who are typically taking multiple medications to manage the complications of ESRD such as anemia, hypertension, mineral and bone disorder, and cardiovascular diseases. Adherence may affect the effectiveness of treatment and result in adverse clinical outcomes if not adhered to. The challenges to adherence are frequent, however, and include complex medication regimens, burden of treatment, medication-related problems, and socioeconomic barriers.

Objectives: This study sought to evaluate the rate of adherence to medication among people on hemodialysis in Erbil City, Iraq, and to determine the factors related to non-adherence to medication.

Methods: This study was a cross section of adult patients on maintenance hemodialysis from the Dialysis Center of Erbil Teaching Hospital. Convenience sampling was used to identify participants. The Morisky Medication Adherence Scale (MMAS-8) was used to measure adherence to medications. The participants were divided into two groups for analysis: high adherence and non-adherence. Descriptive analysis, comparative tests, and multivariable logistic regression were used to determine factors independently associated with non-adherence.

Results: Data from 276 patients were analyzed; only 24.6% had a high adherence rate, while 34.8% had a medium adherence rate and 40.6% had a low adherence rate. The overall non-adherence rate was 75.4%. The mean MMAS-8 score was 5.89 ± 2.06. The most common adherence barrier was feeling burdened by treatment (67.8%), followed by not remembering the medications (43.5%) and careless medication taking (38.4%). Medication side effects (AOR=9.31, 95% CI: 2.13–40.63), difficulty remembering the medications (AOR=8.98, 95% CI: 1.11–72.82), and growing number of medications (AOR=1.18, 95% CI: 1.04–1.34) were independently associated with non-adherence.

Conclusions: Non-adherence to drugs is a significant problem in this Iraqi hemodialyzed population. Results show a high correlation between the difficulties of adherence and medication burden, complexity of treatment, memory problems, and side effects of medication. Pharmacological optimization and management of side effects, reminder systems, and patient support can be interventions that can help increase adherence among dialysis patients.