Pill burden and health-related quality of life across dialysis modalities: a multimodal assessment using KDQOL-36 and eQ-5D-5L
Abstract Background and hypothesis Patients receiving maintenance dialysis experience substantial pill burden from complex comorbidities and intensive treatment regimens. Although higher pill burden is linked to treatment burden and poorer health-related quality of life (HRQoL), optimized pharmacologic management may improve overall well-being. We evaluated the association between pill burden and HRQoL across dialysis modalities. Methods We conducted a cross-sectional study of adult patients receiving maintenance hemodialysis (HD), hemodiafiltration (HDF), or peritoneal dialysis (PD) at a tertiary care center. Pill burden was defined as the total number of oral tablets taken daily and categorized as <10, 10–15, or >15 tablets/day. HRQoL was assessed using validated Thai versions of the Kidney Disease Quality of Life-36 (KDQOL-36) and EQ-5D-5L questionnaires. Univariable and multivariable linear regression analyses evaluated associations between pill burden and HRQoL outcomes after adjustment for confounders. Results A total of 156 patients were included: 64 HD, 64 HDF, and 28 PD patients. Median pill burden was 11.5, 10, and 7.5 tablets/day in the HD, HDF, and PD groups, respectively. Antihypertensive and CKD–mineral and bone disorder medications were the main contributors. After adjustment, pill burden was not significantly associated with PCS-12, MCS-12, SPKD, EKD, or EQ-5D-5L-VAS scores. However, patients receiving >15 tablets/day had significantly lower BKD scores, while higher pill burden was independently associated with higher EQ-5D-5L index scores. HDF and PD were consistently associated with better HRQoL than HD. Conclusions Pill burden demonstrated a complex relationship with HRQoL. Dialysis modality appeared to exert a stronger influence on HRQoL than pill burden itself.