Development of a Predictive Nomogram for Estimating Medication Nonadherence in Hemodialysis Patients.

ABSTRACT

BACKGROUND Medication compliance in hemodialysis patients affects the therapeutic effect of treatment and patient survival. Therefore, we aimed to explore the influencing factors of medication adherence in hemodialysis patients and develop a nomogram model to predict medication adherence. MATERIAL AND METHODS Data from questionnaires on medication adherence in hemodialysis patients were collected in Chengde from May 2020 to December 2020. The least absolute selection operator (LASSO) regression model and multivariable logistic regression analysis were used to analyze the risk factors for medication adherence in hemodialysis patients, and then a nomogram model was established. The bootstrap method was applied for internal validation. The concordance index (C-index), area under the receiver operating characteristic (ROC) curve (AUC), decision curve analysis (DCA), calibration curve, net reclassification improvement (NRI) index, and integrated discrimination improvement (IDI) index were used to evaluate the degree of differentiation and accuracy of the nomogram model, and clinical impact was used to investigate the potential clinical value of the nomogram model. RESULTS In total, 206 patients were included in this study, with a rate of medication nonadherence of 41.75%. Eight predictors were identified to build the nomogram model. The C-index, AUC, DCA, calibration curve, NRI, and IDI showed that the model had good discrimination and accuracy. The clinical impact plot showed that the nomogram of medication adherence in hemodialysis patients had clinical application value. CONCLUSIONS We developed and validated a nomogram model that is intuitive to apply for predicting medication adherence in hemodialysis patients.