Cognitive impairment, perceived medication adherence, and high-risk medication use in patients with reduced kidney function: A cross-sectional analysis.
Cognitive impairment, perceived medication adherence, and high-risk medication use in patients with reduced kidney function: A cross-sectional analysis.
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估计肾小球滤过率降低（eGFR < 60 ml/min/1.73 m2）是认知障碍（CI）和药物依从性不良的危险因素。然而，eGFR降低的成人CI与药物依从性之间的关系尚未得到充分的研究。我们的实用目的是评估eGFR降低的成人中CI与自我报告的药物依从性、药物数量和潜在高风险药物使用之间的横断面关系。一项针对45岁及以上eGFR降低的社区居民CI流行病学的观察性队列研究。我们的分析队列包括420名参与者（202名CI，平均年龄：69.7岁），eGFR降低，至少有一种处方药，并且没有遗漏药物依从性数据。有CI的受试者报告良好服药依从性的未调整几率是没有CI的受试者的四倍（自我报告缺药<4天/月；比值比[OR]: 4.04, 95%可信区间[CI]: 1.62-10.10）。在调整人口统计学因素和合并症后，这种差异仍然存在（OR: 5.50, 95% CI: 1.86-16.28）。有CI的参与者并不比没有CI的参与者更有可能将健忘作为漏服药物剂量的原因。平均而言，有CI的参与者比没有CI的参与者服用更多的总药物（平均值：13.3 vs 11.5，中位数：12 vs 11）和更多的高风险药物（平均值：5.0 vs 4.2，中位数：5 vs 4）；这些差异随着人口统计学和合并症的调整而减弱，不再显著。鉴于CI与药物依从性之间有充分的文献记录，CI患者中更好的自我报告药物依从性可能代表了依从性的感知而不是实际依从性。平均而言，有CI的参与者比没有CI的参与者服用了更多的总药物和更多的高风险药物，这表明药物不良事件的风险可能增加。我们的研究结果强调了在eGFR降低的CI患者中依赖自我报告的药物依从性的潜在风险。
Reduced estimated glomerular filtration rate (eGFR < 60 ml/min/1.73 m2) is a risk factor for cognitive impairment (CI) and medication nonadherence. However, the association between CI and medication adherence in adults with reduced eGFR has not been adequately examined. Our pragmatic objectives were to assess the cross‐sectional relationship between CI and self‐reported medication adherence, medication number, and use of potentially high‐risk medications among adults with reduced eGFR. An observational cohort study of the epidemiology of CI in community‐dwelling adults aged 45 years or older with reduced eGFR. Our analytic cohort consisted of 420 participants (202 with CI; mean age: 69.7 years) with reduced eGFR, at least one prescription medication, and nonmissing medication adherence data. Participants with CI had four times greater unadjusted odds of reporting good medication adherence than participants without CI (self‐report of missing medications <4 days/month; odds ratio [OR]: 4.04, 95% confidence interval [CI]: 1.62–10.10). This difference persisted following adjustment for demographic factors and comorbidities (OR: 5.50, 95% CI: 1.86–16.28). Participants with CI were no more likely than participants without CI to report forgetfulness as a reason for missing medication doses. Participants with CI were, on average, taking more total (mean: 13.3 vs. 11.5, median: 12 vs. 11) and more high‐risk (mean: 5.0 vs. 4.2, median: 5 vs. 4) medications than those without CI; these differences were attenuated and no longer significant following adjustment for demographics and comorbidities. Given the well‐documented association between CI and medication nonadherence, better self‐reported medication adherence among those with CI may represent perceptions of adherence rather than actual adherence. Participants with CI were, on average, taking more total and more high‐risk medications than those without CI, suggesting a possible increased risk for adverse drug events. Our results highlight the potential risks of relying on self‐reported medication adherence in reduced eGFR patients with CI.