Pharmacy World & Science

, Volume 30, Issue 5, pp 571–576 | Cite as

Overcoming obstacles for adherence to phosphate binding medication in dialysis patients: a qualitative study

  • Magnus LindbergEmail author
  • Per Lindberg
Research Article


Objective The aim of this study was to explore obstacles to adherence to phosphate binding medication and to describe the measures taken by dialysis patients to overcome these obstacles. Setting A Swedish renal unit. Method Ten patients undergoing dialysis were interviewed. The interviews were semi-structured and were analysed according to qualitative content analysis. Main outcome measure Statements about barriers and the ways to overcome these. Results Non user-friendly drug compound, feeling of discomfort, forgetfulness, polypharmacy and patient ignorance were identified as obstacles to adherence to phosphate binding medication. Measures taken by the patients to handle obstacles were identified as using a dispensing aid, consuming extra water and exercising routines. Conclusion Dialysis patients identify obstacles that impede patient adherence to prescribed phosphate binding medication. The patients overcame most obstacles by self-management but not always in concordance with treatment requirements. Our findings imply that the ways the patient conquer each barrier need to be considered when strategies for self-management are promoted.


Adherence Dialysis End-stage kidney disease Medication therapy management Patient compliance Phosphate-binding medication Qualitative research Sweden 



We are grateful for the help received from registered nurses Helena Lövén and Marina Levin-Karlsson. As a part of their bachelor education in nursing they prepared the analysis for this study. We would also like to thank the two anonymous reviewers who significantly contributed to improving the manuscript.


This study was financially supported by the County Council of Gävleborg.

Conflict of interest

The authors have no conflict of interest in connection with the content of this study.


  1. 1.
    Mallick NP, Gokal R. Haemodialysis. Lancet. 1999;353(9154):737–42.PubMedCrossRefGoogle Scholar
  2. 2.
    Painter P. Physical functioning in end-stage renal disease patients: update 2005. Hemodial Int. 2005;9(3):218–35.PubMedCrossRefGoogle Scholar
  3. 3.
    Gokal R, Mallick NP. Peritoneal dialysis. Lancet. 1999;353(9155):823–8.PubMedCrossRefGoogle Scholar
  4. 4.
    Lorig KR, Holman H. Self-management education: history, definition, outcomes, and mechanisms. Ann Behav Med. 2003;26(1):1–7.PubMedCrossRefGoogle Scholar
  5. 5.
    Finn WF. Phosphorus management in end-stage renal disease. Semin Dial. 2005;18(1):8–12.PubMedCrossRefGoogle Scholar
  6. 6.
    Bellasi A, Kooienga L, Block GA. Phosphate binders: new products and challenges. Hemodial Int. 2006;10(3):225–34.PubMedCrossRefGoogle Scholar
  7. 7.
    Cleary DJ, Matzke GR, Alexander AC, Joy MS. Medication knowledge and compliance among patients receiving long-term dialysis. Am J Health Syst Pharm. 1995;52(17):1895–900.PubMedGoogle Scholar
  8. 8.
    Young EW, Akiba T, Albert JM, McCarthy JT, Kerr PG, Mendelssohn DC, et al. Magnitude and impact of abnormal mineral metabolism in hemodialysis patients in the Dialysis Outcomes and Practice Patterns Study (DOPPS). Am J Kidney Dis. 2004;44(5 Suppl 2):34–8.PubMedCrossRefGoogle Scholar
  9. 9.
    Kaplan B, Mason NA, Shimp LA, Ascione FJ. Chronic hemodialysis patients. Part I: characterization and drug-related problems. Ann Pharmacother. 1994;28(3):316–9.PubMedGoogle Scholar
  10. 10.
    Manley HJ, Garvin CG, Drayer DK, Reid GM, Bender WL, Neufeld TK, et al. Medication prescribing patterns in ambulatory haemodialysis patients: comparisons of USRDS to a large not-for-profit dialysis provider. Nephrol Dial Transplant. 2004;19(7):1842–8.PubMedCrossRefGoogle Scholar
  11. 11.
    Lindberg M, Lindberg P, Wikström B. Medication discrepancy: a concordance problem between dialysis patients and caregivers. Scand J Urol Nephrol. 2007;41(6):546–52.CrossRefPubMedGoogle Scholar
  12. 12.
    Claxton AJ, Cramer J, Pierce C. A systematic review of the associations between dose regimens and medication compliance. Clin Ther. 2001;23(8):1296–310.PubMedCrossRefGoogle Scholar
  13. 13.
    Leggat JE Jr, Orzol SM, Hulbert-Shearon TE, Golper TA, Jones CA, Held PJ, et al. Noncompliance in hemodialysis: predictors and survival analysis. Am J Kidney Dis. 1998;32(1):139–45.PubMedCrossRefGoogle Scholar
  14. 14.
    Bissell P, Ryan K, Morecroft C. Narratives about illness, medication: a neglected theme/new methodology within pharmacy practice research. Part I: conceptual framework. Pharm World Sci. 2006;28(2):54–60.PubMedCrossRefGoogle Scholar
  15. 15.
    Graneheim UH, Lundman B. Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness. Nurse Educ Today. 2004;24(2):105–12.PubMedCrossRefGoogle Scholar
  16. 16.
    Loghman-Adham M. Medication noncompliance in patients with chronic disease: issues in dialysis and renal transplantation. Am J Manag Care. 2003;9(2):155–71.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. 2008

Authors and Affiliations

  1. 1.Centre for Research and DevelopmentUppsala University/County Council of GävleborgGävleSweden
  2. 2.Department of Public Health and Caring SciencesUppsala UniversityUppsalaSweden
  3. 3.Department of PsycologyUppsala UniversityUppsalaSweden

Personalised recommendations