Living with Medicines and its Impact on Quality of Life in Dialysis Patients in West Bank, Palestine.

Reem Hasan Abdel Majeed Natsheh
ريم حسن عبد المجيد نتشه
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Al-Quds University
Background: End-stage renal disease (ESRD) is the final stage of chronic kidney disease (CKD), characterized by an irreversible loss of kidney function. Globally, the prevalence of ESRD is increasing, resulting in a significant economic and health burden for patients and the health system. This study aims to investigate the impact of medication burden and adherence on health-related quality of life (HR-QOL) for patients who received hemodialysis in the West Bank, Palestine. Methods: A cross-sectional study was conducted to assess HR-QOL through the KDQOL-36TM questionnaire, medication-related burden through the LMQ-3 scale, and medication adherence using the ARMS questionnaire in 120 hemodialysis (HD) patients. The sample was recruited from two dialysis units at the Ministry of Health Hospital (the Palestinian Medical Complex (PMC) in Ramallah and the Hebron Governmental Hospital in Hebron). Results: The majority of HD patients were between 50 and 69 years old (30.8%), resided in villages (62.5%), were married (83.3%), and had a relatively even distribution between males (47.5%) and females (52.5%). The overall HR-QOL global score was 1958.5 (IQR= 2007.50) out of a possible 3600, indicating a moderate level of quality of life. Among the HR-QOL dimensions, symptoms and problems of kidney disease had the highest mean score, while burdens of kidney disease had the lowest. The majority of HD patients (45.8%) experienced a moderate burden. Patient-doctor relationships, effectiveness, and cost-related burden have been shown to be the most significantly influencing factors in medication burden. According to the ARMS scale, the majority of participants (73.3%) had low adherence to their medicine. Correlation tests revealed significant negative relationships between medication-related burden and HR-QOL (R= -0.431, p-value < 0.05), indicating higher medication-related burden is associated with poorer quality of life. Additionally, a positive relationship between medication-related burden and non-adherence (R= 0.61, p-value < 0.05) indicates that higher medication-related burden is associated with higher non-adherence. Conclusion: This study reveals significant insights about the HR-QOL, medication burden, and adherence of HD patients in the West Bank. The study shows that among HD patients, medication burden significantly lowers HR-QOL and increases medication non-adherence. The findings highlight the importance of addressing medication burden as a component of comprehensive treatment to improve patients' quality of life and enhance medication adherence among HD patients.