Related Experiment Video
Updated: Aug 5, 2025
Using Continuous Data Tracking Technology to Study Exercise Adherence in Pulmonary Rehabilitation
Published on: November 8, 2013
Social determinants of patiromer adherence and abandonment: An observational, retrospective, real-world claims
Nathan Kleinman1, Jennifer Kammerer2, Kevin LaGuerre3
1Kleinman Analytic Solutions, LLC, Philadelphia, PA, United States of America.
Insights
Social determinants of health significantly impact adherence to hyperkalemia treatments like patiromer. Factors such as income, employment, and education influence prescription adherence and abandonment in chronic kidney disease patients.
Area of Science:
- Nephrology
- Public Health
- Health Economics
Background:
- Hyperkalemia is a serious complication of chronic kidney disease (CKD).
- Patiromer is a novel therapy for chronic hyperkalemia, but its effectiveness depends on patient adherence.
- Social determinants of health (SDOH) significantly influence health conditions and treatment adherence.
Purpose of the Study:
- To examine the influence of SDOH on adherence to patiromer for hyperkalemia treatment.
- To identify factors associated with patiromer prescription abandonment.
Main Methods:
- Retrospective, real-world claims analysis of adult patiromer users (2015-2020).
- Incorporated SDOH data from census records.
- Defined adherence as >80% proportion of days covered (PDC) and abandonment as reversed claims.
Main Results:
- 48% of patients achieved >80% PDC at 60 days; 25% at 6 months.
- Higher PDC was linked to older age, male sex, insurance coverage, and nephrologist prescription.
- Lower PDC and higher abandonment correlated with higher out-of-pocket costs, unemployment, poverty, disability, and CKD with heart failure.
Conclusions:
- SDOH, including socioeconomic status and education, are associated with lower patiromer adherence.
- Prescription abandonment is higher among patients with higher costs, disability, and specific demographic factors.
- Addressing SDOH is crucial for improving drug adherence and patient outcomes in hyperkalemia management.
Background:
Hyperkalemia is a frequent and serious complication in chronic kidney disease (CKD) that can impede continuation of beneficial evidence-based therapies. Recently, novel therapies such as patiromer have been developed to treat chronic hyperkalemia, but their optimal utility hinges on adherence. Social determinants of health (SDOH) are critically important and can impact both medical conditions and treatment prescription adherence. This analysis examines SDOH and their influence on adherence to patiromer or abandonment of prescriptions for hyperkalemia treatment.
Methods:
This was an observational, retrospective, real-world claims analysis of adults with patiromer prescriptions and 6- and 12-months pre- and post-index prescription data in Symphony Health's Dataverse during 2015-2020, and SDOH from census data. Subgroups included patients with heart failure (HF), hyperkalemia-confounding prescriptions, and any CKD stages. Adherence was defined as >80% of proportion of days covered (PDC) for ≥60 days and ≥6 months, and abandonment as a portion of reversed claims. Quasi-Poisson regression modeled the impact of independent variables on PDC. Abandonment models used logistic regression, controlling for similar factors and initial days' supply. Statistical significance was p<0.05.
Results:
48% of patients at 60 days and 25% at 6 months had a patiromer PDC >80%. Higher PDC was associated with older age, males, Medicare/Medicaid coverage, nephrologist prescribed, and those receiving renin-angiotensin-aldosterone system inhibitors. Lower PDC correlated with higher out-of-pocket cost, unemployment, poverty, disability, and any CKD stage with comorbid HF. PDC was better in regions with higher education and income.
Conclusions:
SDOH (unemployment, poverty, education, income) and health indicators (disability, comorbid CKD, HF) were associated with low PDC. Prescription abandonment was higher in patients with prescribed higher dose, higher out-of-pocket costs, those with disability, or designated White. Key demographic, social, and other factors play a role in drug adherence when treating life-threatening abnormalities such as hyperkalemia and may influence patient outcomes.
Related Concept Videos
01:19Pharmacovigilance
This process, termed pharmacovigilance, aims to detect, evaluate, and minimize harmful effects related to medication use. The data collection for pharmacovigilance depends on spontaneous reporting systems, where healthcare professionals or patients voluntarily report suspected ADRs.
In some cases, there...
01:23Types of Biopharmaceutical Studies: Controlled and Non-Controlled Approaches
Non-controlled studies, commonly employed for initial exploration, lack a control group, rendering them susceptible to biases and external influences. In contrast,...
01:26Methods of Documentation II: POMR
01:15Methods of Documentation VI: Case Management Model
For example, a patient with a chronic...
01:25Factors Influencing Drug Absorption: Disease States and Pharmacology
Substances such as alcohol and specific drugs, including antineoplastics, can also negatively impact drug absorption. For instance,...
01:12Relative Risk