S..LOW1, A. CHAN1, A. MOH1, Y. SHAO1, S.C.LIM1
Khoo Teck Puat Hospital1
Diabetes-related chronic kidney disease (CKD) is a major public health problem. Although medication adherence is a key contributor to achieving treatment goals, there is paucity of data on how medication adherence can prevent or delay CKD progression in diabetes.
This was a prospective cohort study of 529 patients with type 2 diabetes (T2D) recruited from DORIS cohort. Medication adherence to hypoglycemic, hypolipidemic anti-hypertensive medications was calculated from percentage of days covered(PDC) which was number of days with medication divided by number of days in the specific time interval. PDC ≥80% is considered adherence to medication. CKD progression was defined as deterioration across KDIGO estimated glomerular filtration rate categories with ≥25% drop from baseline. Multivariable logistic regression was used to examine the association between PDC and PDC≥80% with CKD progression, adjusting for demographics, socio-economic, clinical covariates and quality of life.
The mean age of participants was 57.5 ± 11.7 years. About 74% were adherent to medications. Over a follow-up period of up to 3.7 years, 25.0% of participants experienced CKD progression. Higher PDC, indicative of increasing adherence, was associated with lower odds of CKD progression in univariable and multivariable models with odds ratios (OR) 0.32 (95%CI 0.10-1.00; p=0.051) and 0.06 (95%CI 0.01-0.34; p=0.002). Similarly, PDC≥80% was associated with lower odds of CKD progression with OR 0.44 (95%CI 0.22-0.90; p=0.024) in the fully adjusted model.
Medication adherence confers a protective effect on renal trajectory in T2D. This is a potential intervention point for effective strategy in prevention of CKD.