Pill burden affects quality of life

20 Sep 2016. NUS pharmacists have discovered that the quality of life of pre-dialysis patients may be affected more by pill burden than complications associated with chronic kidney disease (CKD).

Patients with CKD commonly experience multiple complications such as anaemia and bone disease. Their quality of life is often adversely affected. A research team led by Prof Priscilla HOW from the Department of Pharmacy, NUS studied the relationship between anaemia and bone disease, and the quality of life in CKD patients. The research team also included members from NUH’s Division of Nephrology. Their results showed that neither anaemia nor bone disease impacted the quality of life in pre-dialysis patients with CKD. More interestingly, they found that patients with bone disease who had a high pill burden experienced a poorer quality of life. This finding is of great importance to clinicians as reducing the number of pills for these patients could potentially improve their quality of life.

Patients with CKD are frequently prescribed complex therapeutic regimens. For instance, many CKD patients have diabetes, high blood pressure and high blood cholesterol and are prescribed an average of 12 medications. This contributes to a high pill burden for these patients. The findings from this research address the need to streamline medication therapy and reduce the pill burden to achieve optimal care in CKD patients. This could in turn improve their quality of life, which is now considered an important measure and “soft” outcome in patient care.

While anaemia and bone disease were not associated with the quality of life in CKD patients, the total daily pill burden in pre-dialysis patients with bone disease had a negative impact on their quality of life. Pharmacists play a critical role in reviewing medication lists and performing medication reconciliation routinely so as to reduce patients’ total daily pill burden whenever possible. Pharmacists may also participate in multidisciplinary CKD patient care teams to provide medication assessment and management. These pharmacy services contribute to efforts to optimise drug therapy and improve clinical and patient-reported outcomes such as quality of life in the CKD population.

The research team is also actively investigating other aspects related to quality of life in pre-dialysis and dialysis patients, such as comparing the quality of life between hemodialysis and peritoneal dialysis patients, and the effects of a multidisciplinary, collaborative management clinic on the quality of life of new hemodialysis patients. The knowledge gained will provide understanding of the effect of different stages of CKD on patients’ self-reported health outcomes.                

 31. Priscilla How PHA 20160803

Visual giving an impression of the high pill burden of CKD patients.



HL Wee, Seng B, JJ Lee, Tyagi P, Vathsala A, How P. “Association of Anemia and Mineral and Bone Disorders on Health-Related Quality of Life in Predialysis Patients”. Health Qual Life Outcomes 2016 Jun 24;14(1):94. doi: 10.1186/s12955-016-0477-8.