As with other chronic condition, medication noncompliance has a harmful impact in reaching therapeutic goals of delaying the progression of chronic kidney disease (CKD). The aims of a study conducted by Moreira and coworkers in Brazil were to calculate the prevalence of medication noncompliance and to identify medication noncompliance-associated factors in CKD. A cross-sectional study was performed with 130 CKD patients from a university nephrology outpatient clinic, mean age 48.8 +/- 15.8 years, who were (a) continuously self-administering an antihypertensive or immunosuppressive drug and (b) neither on dialysis nor had received a kidney transplant. Noncompliance was measured through self-report (during an interview) and physician assessment. Patients were considered noncompliers if noncompliance had been detected by any of these methods. Sociodemographic, clinical and laboratory, and medication characteristics were surveyed, as well as patients' knowledge regarding prescribed medicines and opinions of the quality of the health care service provided. Prevalence of medication noncompliance was 36.9%. Lack of access to medicines was the most commonly reported problem with medication use (62.5%). Multiple logistic regression analysis showed that patients' insufficient knowledge regarding prescribed medicines and bad opinions of the quality of the provided health care service were independently associated with noncompliance.

WHAT THE STUDY MAY MEAN TO YOU AS A HEALTH CARE PROVIDER: Medication noncompliance prevalence was high among the patients studied. Lack of access to medicines remains an important public health problem. Other noncompliance-associated factors identified in CKD were the patients' poor knowledge regarding the pharmacotherapy and dissatisfaction with the health care service provided. Considering the low rate of adherence, a more systematic approach to teaching patients about managing their chronic kidney is warranted. Self-management training would seem as the best intervention to take with CKD patients. In addition, health care providers also need to take an active role in insuring that patients have access to the medications they need to take. Adherence cannot be expected if patients do not have whatever drugs they need to take.

WHAT THE STUDY MAY MEAN TO YOU AS A PATIENT: Nonadherence to medication regimes is too common in patients with a chronic illness. Yet, whatever condition you have, it cannot be controlled if you do not comply with whatever instructions you have been given. In the long run, it is up to you to perform self-management skills to control your illness. However, you cannot do this if not taught the steps you need to take. If you are uncertain as to what to do, ask your health care provider. You also need to talk him or her if you do not have access to the drugs you need to take. Together, you and your health care provider can likely work things out in a way that benefits you in controlling your illness.

LB Moreira et al. Medication noncompliance in chronic kidney disease. Journal of Nephrology, 2008;21:354-362.