MEDICATION ADHERENCE, DEPRESSIVE SYMPTOMS AND THEIR CLINICAL PREDICTORS IN CHRONIC KIDNEY DISEASE: FINDINGS FROM A TERTIARY CARE HOSPITAL IN PAKISTAN
Author(s)
Adeel Aslam, PharmD MPhil PhD1, Shazia Jamshed, PhD2, Anan Fatima, PharmD MPhil3, Sumera Saeed Akthar, PhD4, Edit Paulik, MD PhD5, Márió Gajdács, MPH, MSc, PharmD, PhD5.
1Universiti Teknologi MARA (UiTM), Selangor, Malaysia, 2International Islamic University Malaysia, Kuantan, Malaysia, 3The University of Lahore, Lahore, Pakistan, 4University of Otago, Otago, New Zealand, 5Department of Public Health, University of Szeged, Szeged, Hungary.
1Universiti Teknologi MARA (UiTM), Selangor, Malaysia, 2International Islamic University Malaysia, Kuantan, Malaysia, 3The University of Lahore, Lahore, Pakistan, 4University of Otago, Otago, New Zealand, 5Department of Public Health, University of Szeged, Szeged, Hungary.
OBJECTIVES: Chronic kidney disease (CKD) represents a major global public health burden, where patients frequently encounter severe psychological comorbidities, alongside complex therapeutic regimens that lead to suboptimal compliance. This interplay accelerates disease progression, escalating healthcare resource utilization, and compromises health-related quality of life (HRQoL). This study aimed to assess medication adherence, evaluate the prevalence and severity of depressive symptoms, and to identify predictors of depression among CKD patients in a major tertiary-care hospital in Lahore, Pakistan.
METHODS: A single-center observational study was conducted between February-December 2024. Adult CKD patients (representing Stages 1-5) were recruited to participate, where data collection was carried out using a structured, multi-domain instrument, capturing: i) detailed socio-demographic and clinical parameters, ii) Morisky Medication Adherence Scale (MMAS-4), and iii) Hamilton Depression Rating Scale (HDRS). Statistical analyses (descriptive statistics, χ² tests and binary logistic regression models) were performed using IBM SPSS Statistics 25.0 (α: 0.05; adjusted odds ratios (aOR)±95% confidence interval [CI]).
RESULTS: The final sample (N=180) of CKD-patents were 53.3% male, with the 45-54 age bracket being the most numerous. 37.4% reported unintentional non-adherence (forgetfulness), while 36.9% exhibited careless compliance behaviors, 36.2% practiced intentional non-adherence when feeling asymptomatic, and 46.1% discontinued therapy when experiencing adverse events. Depressive symptoms were detected in 81.6% of patients, classified as mild (32.2%), moderate (28.9%), and severe (20.6%), according to HDRS criteria. Muliple regression analyses showed that duration of CKD >2 years was the strongest predictor of depressive state (aOR:6.23; 95%CI: 2.94-13.20), followed by low medication adherence (aOR:4.17; 95%CI: 2.09-8.31), illiteracy (aOR:3.58; 95%CI: 1.71-7.49) and advanced-stage CKD disease (aOR:3.41; 95%CI: 1.87-6.21) (p<0.001 in all cases).
CONCLUSIONS: Depressive symptoms were highly prevalent among CKD patients; to interrupt this bidirectional cycle of physical and psychological decline, healthcare providers must transition away from fragmented treatment silos to integrated care.
METHODS: A single-center observational study was conducted between February-December 2024. Adult CKD patients (representing Stages 1-5) were recruited to participate, where data collection was carried out using a structured, multi-domain instrument, capturing: i) detailed socio-demographic and clinical parameters, ii) Morisky Medication Adherence Scale (MMAS-4), and iii) Hamilton Depression Rating Scale (HDRS). Statistical analyses (descriptive statistics, χ² tests and binary logistic regression models) were performed using IBM SPSS Statistics 25.0 (α: 0.05; adjusted odds ratios (aOR)±95% confidence interval [CI]).
RESULTS: The final sample (N=180) of CKD-patents were 53.3% male, with the 45-54 age bracket being the most numerous. 37.4% reported unintentional non-adherence (forgetfulness), while 36.9% exhibited careless compliance behaviors, 36.2% practiced intentional non-adherence when feeling asymptomatic, and 46.1% discontinued therapy when experiencing adverse events. Depressive symptoms were detected in 81.6% of patients, classified as mild (32.2%), moderate (28.9%), and severe (20.6%), according to HDRS criteria. Muliple regression analyses showed that duration of CKD >2 years was the strongest predictor of depressive state (aOR:6.23; 95%CI: 2.94-13.20), followed by low medication adherence (aOR:4.17; 95%CI: 2.09-8.31), illiteracy (aOR:3.58; 95%CI: 1.71-7.49) and advanced-stage CKD disease (aOR:3.41; 95%CI: 1.87-6.21) (p<0.001 in all cases).
CONCLUSIONS: Depressive symptoms were highly prevalent among CKD patients; to interrupt this bidirectional cycle of physical and psychological decline, healthcare providers must transition away from fragmented treatment silos to integrated care.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
HSD20
Topic
Epidemiology & Public Health, Health Service Delivery & Process of Care, Organizational Practices
Disease
Urinary/Kidney Disorders