The Impact of Medication Regimen Complexity on Patient-Related and Clinical Outcomes in Patients Undergoing Hemodialysis

Introduction There is limited data on medication regimen complexity on outcomes in patients with kidney failure receiving hemodialysis (HD) in different settings. This study aims to quantify medication regimen complexity and assess its impact on patient-related and clinical outcomes in facility-based and home-based HD-treated patients. Methods This study targeted patients undergoing HD at a large metropolitan dialysis center in Australia. Baseline data and hospitalizations were recorded through a retrospective audit of electronic medical records, while other outcome data were collected prospectively. Medication regimen complexity was assessed using the 65-item Medication Regimen Complexity Index (MRCI). Medication adherence was evaluated with the 4-item Morisky-Green-Levine Scale (MGLS), whereby participants were deemed not adherent if they responded "yes" to any of the questions. EQ-5D-5L and EQ VAS scores were used to assess health-related quality of life (HRQoL) with higher scores indicating better health. Findings Of 174 eligible adults, 145 (80 facility-based and 65 home HDs) patients participated. Participants of both facility-based and home HD were predominantly men (65% and 75.4%, respectively) with a mean age of 62 +/- 13 years and 56 +/- 12 years, respectively. Home HD participants had a higher median MRCI than those on facility-based HD [26.0 (IQR 20.6-33.0) vs. 20.8 (IQR 13.6-28.4), respectively; p = 0.005]. While there was no significant difference in the non-adherence rate, home HD participants had higher scores for both EQ-5D-5L [0.917 (IQR 0.745-0.984) vs. 0.798 (IQR 0.302-0.956), respectively; p = 0.006] and EQ VAS [60 (IQR 50-75) vs. 50 (IQR 40-70), respectively; p = 0.034]. Home HD participants also had a fewer number of hospitalizations in the prior (1 year 0 (IQR 0-1) vs. 1 (IQR 0-1), respectively; p = 0.042). Discussion The higher complexity of the medication regimen for home HD compared to facility-based HD participants may be due to the shift in dose administration responsibility of several parenteral medications. Despite the higher complexity, home HD patients had better outcomes, including HRQoL and hospitalizations compared to facility-based HD patients.