Medication non-adherence in chronic kidney disease patients using Modified Morisky Adherence Scale (MMAS-8)
DOI:
https://doi.org/10.59736/IJP.24.03.1130Keywords:
Medication Adherence, Patient Compliance, Polypharmacy, Renal InsufficiencyAbstract
Background: Chronic kidney disease (CKD) requires long-term medication to slow disease progression and prevent complications; however, treatment complexity, polypharmacy, socioeconomic factors, and disease-related factors can contribute to poor medication adherence. This study assessed medication adherence among patients with CKD and its relationship with selected demographic and clinical variables using the 8-item Modified Morisky Medication Adherence Scale (MMAS-8).
Methods: This Descriptive Cross-Sectional Study was performed in Nephrology Department of Khyber Teaching Hospital, Peshawar. One hundred and fifty-one patients with diagnosed CKD, aged 17-60 years were recruited by consecutive sampling. Demographic and clinical data, such as sex, age, education, income status, CKD stage, diabetes mellitus, hypertension, and the number of medications taken per day was collected. The MMAS-8 medication adherence questionnaire was used to determine medication adherence. Data were analyzed using SPSS version 20. Descriptive statistics, Chi-square/Fisher's exact tests, Mann–Whitney U tests and binary logistic regression analyses were conducted.
Results: 151 people participated, 93 (61.6%) were classified as medication non-adherent and 58 (38.4%) were adherent. There was a significant association of medication non-adherence with hypertension (p=0.027). The number of medications taken per day was the most significant correlate of non-adherence (p<0.001). Medication burden was found to be a significant predictor of medication non-adherence when logistic regression analysis was performed (OR=1.57; p<0.001).
Conclusion: Patient non-compliance with medications is a well-recognized issue with CKD patients. Adherence screening, counselling with the patient, and optimizing medication regimens might help improve adherence and aid in better management of CKD and clinical outcomes.
References
GBD Chronic Kidney Disease Collaboration. Global, regional, and national burden of chronic kidney disease, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet. 2022;400(10365):123-135. doi:10.1016/S0140-6736(22)00370-3.
Jager KJ, Kovesdy C, Langham R, Rosenberg M, Jha V, Zoccali C. A single number for advocacy and communication—worldwide more than 850 million individuals have kidney diseases. Kidney Int. 2019;96(5):1048-1050. doi:10.1016/j.kint.2019.07.012.
Kalantar-Zadeh K, Jafar TH, Nitsch D, Neuen BL, Perkovic V. Chronic kidney disease. Lancet. 2021;398(10302):786-802. doi:10.1016/S0140-6736(21)00519-5.
Kidney Disease: Improving Global Outcomes (KDIGO). Clinical practice guideline for the management of chronic kidney disease. Kidney Int. 2024. doi:10.1016/j.kint.2023.10.018.
O'Hara DV, Yi TW, Lee VW, Jardine M, Dawson J. Digital health technologies to support medication adherence in chronic kidney disease. Nephrology (Carlton). 2022;27(12):917-924. doi:10.1111/nep.14113.
Cheen MH, Tan YZ, Oh LF, Wee HL, Thumboo J. Prevalence of and factors associated with primary medication non-adherence in chronic disease: systematic review and meta-analysis. Int J Clin Pract. 2019;73(6). doi:10.1111/ijcp.13350.
Murali KM, Mullan J, Roodenrys S, Hassan HIC, Lonergan MA. Exploring the agreement between self-reported medication adherence and pharmacy refill-based measures in patients with kidney disease. Patient Prefer Adherence. 2022;16:3465-3477. doi:10.2147/PPA.S388060.
Lam WY, Fresco P. Medication adherence measures: an overview. Biomed Res Int. 2015;2015:217047. doi:10.1155/2015/217047.
Morisky DE, Ang A, Krousel-Wood M, Ward HJ. Predictive validity of a medication adherence measure in an outpatient setting. J Clin Hypertens (Greenwich). 2008;10(5):348-354. doi:10.1111/j.1751-7176.2008.07572.x.
Iranpour A, Sarmadi V, Alian Mofrad A, et al. The Persian version of the 8-item Morisky Medication Adherence Scale (MMAS-8): can we trust it? J Diabetes Metab Disord. 2022;21:835-840. doi:10.1007/s40200-022-01047-7.
Roohi E, Rahmatian D, Borkum M, et al. Medication adherence tools and measures in chronic kidney disease: a systematic review. BMC Nephrol. 2026;27:124. doi:10.1186/s12882-025-04734-8.
Hu EA, Coresh J, Anderson CAM, et al. Adherence to healthy dietary patterns and risk of CKD progression and mortality: findings from CRIC study. Am J Kidney Dis. 2021;77(2):235-244. doi:10.1053/j.ajkd.2020.05.014.
Brown MT, Bussell JK. Medication adherence: WHO cares? Mayo Clin Proc. 2011;86(4):304-314. doi:10.4065/mcp.2010.0579.
Hassan H, et al. Medication adherence among patients with chronic kidney disease: challenges and opportunities in developing countries. BMC Nephrol. 2023. doi:10.1186/s12882-023-03156-4.
Stanifer JW, Turner EL, Egger JR, et al. Knowledge, attitudes, and practices regarding kidney disease among adults in low-resource settings. Kidney Int Rep. 2022. doi:10.1016/j.ekir.2022.04.009.
Jain D, Aggarwal HK, Meel S. Assessment of medication adherence in chronic kidney disease patients: a tertiary care experience. Int J Health Sci Res. 2018;8(11):20-30.
Tesfaye W, Parrish N, Sud K, Grandinetti A, Castelino R. Medication adherence among patients with kidney disease: an umbrella review. Adv Kidney Dis Health. 2024;31(1):68-83. doi:10.1053/j.akdh.2023.08.003.
Wu X, Tang F, Li H, Chen C, Zhang H, Liu X, Lai H, Li Q, Deng L, Ye Z. Development and validation of a nomogram model for medication non-adherence in patients with chronic kidney disease. J Psychosom Res. 2023;171:111385. doi:10.1016/j.jpsychores.2023.111385.
O'Hara DV, Yi TW, Lee VW, Jardine M, Dawson J. Digital health technologies to support medication adherence in chronic kidney disease. Nephrology (Carlton). 2022;27(12):917-924. doi:10.1111/nep.14113.
Roohi E, Rahmatian D, Borkum M, Bredenkamp N, Ho C, Wu H, Haubrich K, Pietrobon A, Gregson S, Atiquzzaman M, Levin A. Medication adherence tools and measures in chronic kidney disease: a systematic review. BMC Nephrol. 2026;27:124. doi:10.1186/s12882-025-04734-8.
Murali KM, Mullan J, Roodenrys S, Hassan HIC, Lonergan MA. Exploring the agreement between self-reported medication adherence and pharmacy refill-based measures in patients with kidney disease. Patient Prefer Adherence. 2022;16:3465-3477. doi:10.2147/PPA.S388060.
Mohammadnezhad G, Ehdaivand S, Sebty M, Azadmehr B, Esmaily H. Chronic kidney disease and adherence improvement program by clinical pharmacist-provided medication therapy management; a quasi-experimental assessment of patients' self-care perception and practice. BMC Nephrol. 2024;25:463. doi:10.1186/s12882-024-03902-6.
Morisky DE, Ang A, Krousel-Wood M, Ward HJ. Predictive validity of a medication adherence measure in an outpatient setting. J Clin Hypertens (Greenwich). 2008;10(5):348-354. doi:10.1111/j.1751-7176.2008.07572.x.
Downloads
Published
Issue
Section
License
Copyright (c) 2026 Muneed Munawar, Ahmad Zeb
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Readers may “Share-copy and redistribute the material in any medium or format” and “Adapt-remix, transform, and build upon the material”. The readers must give appropriate credit to the source of the material and indicate if changes were made to the material. Readers may not use the material for commercial purpose. The readers may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.
