Pill burden and health-related quality of life across dialysis modalities: a multimodal assessment using KDQOL-36 and eQ-5D-5L

Background and hypothesis: Patients receiving maintenance dialysis experience substantial pill burden from complex comorbidities and intensive treatment regimens. Although higher pill burden is linked to treatment burden and poorer health-related quality of life (HRQoL), optimized pharmacologic management may improve overall well-being. We evaluated the association between pill burden and HRQoL across dialysis modalities. Methods: We conducted a cross-sectional study of adult patients receiving maintenance hemodialysis (HD), hemodiafiltration (HDF), or peritoneal dialysis (PD) at a tertiary care center. Pill burden was defined as the total number of oral tablets taken daily and categorized as <10, 10–15, or >15 tablets/day. HRQoL was assessed using validated Thai versions of the Kidney Disease Quality of Life-36 (KDQOL-36) and EQ-5D-5L questionnaires. Univariable and multivariable linear regression analyses evaluated associations between pill burden and HRQoL outcomes after adjustment for confounders. Results: A total of 156 patients were included: 64 HD, 64 HDF, and 28 PD patients. Median pill burden was 11.5, 10, and 7.5 tablets/day in the HD, HDF, and PD groups, respectively. Antihypertensive and CKD–mineral and bone disorder medications were the main contributors. After adjustment, pill burden was not significantly associated with PCS-12, MCS-12, SPKD, EKD, or EQ-5D-5L-VAS scores. However, patients receiving >15 tablets/day had significantly lower BKD scores, while higher pill burden was independently associated with higher EQ-5D-5L index scores. HDF and PD were consistently associated with better HRQoL than HD. Conclusions: Pill burden demonstrated a complex relationship with HRQoL. Dialysis modality appeared to exert a stronger influence on HRQoL than pill burden itself.