Associations Between Pill Burden and Kidney Disease Quality of Life (KDQoL) Among Patients on Maintenance Hemodialysis (HD) and the Impact of More Potent Phosphorus Binding Therapy

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Background: Patients who receive maintenance HD therapy have a high pill burden, which has been associated with lower health-related quality of life (HRQoL). We hypothesize that phosphate binder (PB) pill burden is associated with HRQoL in HD patients. Prior studies were conducted before more potent PB with lower pill burdens were frequently used. Methods: This was a cross-sectional study of adult, in-center HD patients from Fresenius Kidney Care (FKC) facilities who filled out KDQoL-SF 36 in 2019, were prescribed PB monotherapy, with pill burden recorded within 30 days prior to/on KDQoL survey completion date (n=17,757). Stratified random sampling was used to select the study cohort (n=500) defined by PB pills/day (≤3, >3 to 6, >6 to 9, >9 to 12, and >12) and matched for age. As a sensitivity analysis, we examined the association between total pill burden (quartiles of total pills/day: ≤13, >13 to 18, >18 to 24, and >24) and KDQoL. Higher scores are indicative of higher quality of life. ANOVA, chi square, linear regression and logistic regression were utilized. Results: PB pill burden was not significantly associated with KDQoL summary scores but was significantly associated with the bothered by fluid restriction question (Table). Total pill burden was associated with symptoms/problems (score of 84.1 to 78.2 from Q1 to Q4 of total pills), effects of kidney disease (80.0 to 75.6), physical health (41.4 to 36.1) and mental health (54.3 to 51.6), as well as the bothered by fluid restriction question (74.6 to 65.5). Conclusions: Among HD patients, both higher PB pill burden and total daily pills were associated with higher likelihood to be bothered with fluid restriction. The additional fluid consumption needed to consume pills may need to be examined among patients who struggle with fluid restrictions. Funding: Commercial Support - Fresenius Medical Care

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