• Pavithra Cirevalli Department of Pharmacy Practice, Sree Vidyanikethan College of Pharmacy, Tirupati, India
  • Harini Devi Nimmanapalli Department of Biochemistry (MD), Assistant Professor, SVIMS, Tirupati, India,
  • Lalith Kumar Parlapalli Department of Pharmacy Practice, Sree Vidyanikethan College of Pharmacy, Tirupati, India
  • Lakshmi Sowjanya Nuthalapati Department of Pharmacy Practice, Sree Vidyanikethan College of Pharmacy, Tirupati, India
  • Anitha Kuttiappan Department of Pharmacology, Assistant Professor, Sree Vidyanikethan College of Pharmacy, Tirupati, India,
  • Siva Kumar Vishnu Bhotla Department of Nephrology (DM), Senior Professor, SVIMS, Tirupati, India


Objective: The objective of the study was to assess the pill burden (PB), drug class distribution and financial burden for buying medicines in different treatment modalities of chronic kidney disease (CKD) patients.

Methods: A prospective, cross-sectional study was performed in 244 CKD patients and they were divided into 4 groups as follows: pre-dialysis patients (stages 1-5) as group 1, hemodialysis (HD) patients as group 2, peritoneal dialysis (PD) patients as group 3 and renal transplant recipient (RTR) patients as group 4. Data was collected in pre-designed form through direct patient interaction.

Results: Out of 244 CKD patients, PB considering the total number of pills/d in different modalities is 12±5 in pre-dialysis, 10±3 in HD, 13±5 in PD, 14±7 in RTR and for the number of drug classes/d in different modalities is 7±3 in pre-dialysis, 7±2 in HD, 8±3 in PD and 9±3 in RTR. On average mean PB in a number of pills/d is 12±5 and number of drug classes/d is 8±3. Among all the patients, the RTR individuals are having high medicinal expenditure in comparison to the other modalities.

Conclusion: PB for the number of pills/d is highest in RTR and almost similar in different modalities. Great improvement in reducing the PB as well as financial burden directly or indirectly improves the patient compliance as well as the quality of life.

Keywords: Chronic kidney disease, Pill burden, Drug class distribution, Financial burden, Predialysis, Hemodialysis, Peritoneal dialysis, Renal transplant recipient


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Author Biography

Harini Devi Nimmanapalli, Department of Biochemistry (MD), Assistant Professor, SVIMS, Tirupati, India,
Department of Biochemistry


1. Eknoyan G, Lameire N, Barsoum R, Eckardt UK, Levin A, Levin N, et al. The burden of kidney disease: improving global outcomes. Kidney Int 2004;66:1310-4.
2. Jessani S, Bux R, Jafar TH. Prevalence, determinants, and management of chronic kidney disease in Karachi, Pakistan-a community based cross-sectional study. BMC Nephrol 2014;15:90.
3. Snyder S, Pendergraph B. Detection and evaluation of chronic kidney disease. Am Fam Physician 2005;72:1723–32.
4. Rajapurkar MM, John GT, Kirpalani AL, Abraham G, Agarwal SK, Almeida AF, et al. What do we know about chronic kidney disease in India: the first report of the Indian CKD registry. BMC Nephrol 2012;13:10.
5. Kumar U, Srikar N. Role of the pharmacist in medical error and medication adherence. Indian J Pharm Sci Res 2012;2:84-92.
6. The USRDS Dialysis Morbidity and Mortality Study: Wave 2. United States Renal Data System. Am J Kidney Dis 1997;30:S67–85.
7. Manley HJ, Garvin CG, Drayer DK, Reid GM, Bender WL, Neufeld TK, et al. Medication prescribing patterns in ambulatory hemodialysis patients: comparisons of USRDS to a large not-for-profit dialysis provider. Nephrol Dial Transplant 2004;19:1842–8.
8. Haynes RB, Ackloo E, Sahota N, McDonald HP, Yao X. Interventions for enhancing medication adherence. Cochrane Database Systematic Reviews 2008.
9. Neri L, Martini A, Andreucci VE, Gallieni M, Rey AL, Brancaccio D, et al. Regimen complexity and prescription adherence in dialysis patients. Am J Nephrol 2011;34:71–6.
10. Ingersoll KS, Cohen J. The impact of medication regimen factors on adherence to chronic treatment: a review of the literature. J Behav Med 2008;31:213–24.
11. Recker RR, Gallagher R, Mac Cosbe PE. Effect of dosing frequency on bisphosphonate medication adherence in a large longitudinal cohort of women. Mayo Clin Proc 2005;80:856–61.
12. Khanna U. The Economics of Dialysis in India. Indian J Nephrol 2009;19:1-4.
13. Smith RE Jr. The clinical and economic burden of anemia. Am J Manag Care 2010;16:S59-66.
14. Elsayed AS, Azab AE. Correlation between chronic kidney diseases and hematolgical data in Sabratha hospital in Libya. Asian J Pharm Clin Res 2017;10:291-6.
15. Van Nooten FE, Green J, Brown R, Finkelstein FO, Wish J. Burden of illness for patients with non-dialysis chronic kidney disease and anemia in the United States: a review of the literature. J Med Econ 2010;13:241-56.
16. National Kidney Foundation: K/DOQI clinical practice guidelines for chronic kidney disease: Evaluation, classification and stratification. Am J Kidney Dis 2002;39 Suppl 1:S1-266.
17. Jha V, Garcia GG, Iseki K, Li Z, Naicker S, Plattner B, et al. Chronic kidney disease: global dimension and perspectives. Lancet 2013;382:260-72.
18. Couser WG, Remuzzi G, Mendis S, Tonelli M. The contribution of chronic kidney disease to the global burden of major non-communicable diseases. Kidney International 2011;80:1258-70.
19. Arora P, Kausz A, Obrador G, Ruthazer R, Khan S, Jenuleson CS, et al. Hospital utilization among chronic dialysis patients. J Am Soc Nephrol 2000;11:740–6.
20. Rocco MV, Soucie MJ, Reboussin DM, Mc Clellan WM. Risk factors for hospital utilization in chronic dialysis patients. J Am SocNephrol 1996;7:889–96.
21. Holland DC, Lam M. Predictors of hospitalization and death among pre-dialysis patients: a retrospective cohort study. Nephrol Dial Transplant 2000;15:650–8.
22. Hirth RA, Greer SL, Albert JM, Young EW, Piette JD. Out-Of-Pocket spending and medication adherence among dialysis patients in twelve countries. Health Aff 2008;27:89-102.
23. Kathrine Parker, Milind Nikam, Anuradha Jayanti and Sandip Mitra. Medication burden in CKD-5D: impact of dialysis modality and setting. Clinical Kidney Journal 2014;7:557–61.
24. Adhikari UR, Taraphder A, Hazra A,Das T. Pill burden does not influence compliance with oral medication in recipients of renal transplant. Indian Journal of Pharmacology 2016;48:21-5.
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How to Cite
Cirevalli, P., H. D. Nimmanapalli, L. K. Parlapalli, L. S. Nuthalapati, A. Kuttiappan, and S. K. Vishnu Bhotla. “PILL BURDEN, DRUG CLASS DISTRIBUTION AND FINANCIAL BURDEN FOR BUYING MEDICINES IN DIFFERENT MODALITIES OF CHRONIC KIDNEY DISEASE PATIENTS: CROSS-SECTIONAL STUDY”. International Journal of Pharmacy and Pharmaceutical Sciences, Vol. 10, no. 6, June 2018, pp. 165-70, doi:10.22159/ijpps.2018v10i6.26186.
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