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Medication adherence and growth in children with CKD
Oleh M Akchurin1, Michael F Schneider2, Lucy Mulqueen2
1Due to the number of contributing authors, the affiliations are provided in the Supplemental Material. oakchuri@montefiore.org.
Summary
Nonadherence to recombinant human growth hormone (rhGH) in children with chronic kidney disease (CKD) is linked to poorer growth. Improving adherence to rhGH may enhance growth outcomes in pediatric CKD patients.
Area of Science:
- Pediatric Nephrology
- Growth and Development
- Chronic Kidney Disease (CKD) Management
Background:
- Poor growth is a common complication in children with CKD.
- Medications can often prevent or correct growth failure.
- Prospective data on medication nonadherence in pediatric CKD growth failure is limited.
Purpose of the Study:
- To prospectively examine the prevalence of nonadherence to key medications in children with CKD.
- To determine the association between medication nonadherence and growth velocity in this population.
Main Methods:
- The Chronic Kidney Disease in Children cohort study prospectively collected data on medication adherence.
- Prescription and nonadherence rates for recombinant human growth hormone (rhGH), phosphate binders, alkali, vitamin D, iron, and ESAs were summarized.
- Linear regression models with generalized estimating equations quantified the association between self-reported nonadherence and changes in height z-score.
Main Results:
- Nonadherence rates varied, with nutritional vitamin D at 22% and erythrocyte-stimulating agents at 4%.
- Children nonadherent to rhGH showed no change in height z-score, while adherent children had a significant improvement (0.16 SDs).
- Adherence to rhGH was associated with a greater change in height z-score (0.33 SDs) in children with height ≤3rd percentile.
Conclusions:
- Self-reported nonadherence to rhGH is associated with poorer growth velocity in pediatric CKD.
- Interventions to improve rhGH adherence present an opportunity to enhance patient outcomes.
- Nonadherence to other studied medications was not significantly associated with changes in height z-score.
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