Impact of Non-Adherence on Renal and Cardiovascular Outcomes in US Veterans

Elvira O. Gosmanova, Miklos Z. Molnar, Ahmed Alrifai, Jun L. Lu, Elani Streja, William C. Cushman, Kamyar Kalantar-Zadeh, Csaba P. Kovesdy

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8 Citations (Scopus)


Background: Adherence is paramount in treating hypertension; however, no gold standard method is available for non-adherence screening, delineating high-risk patients. An International Classification of Diseases 9th Edition non-adherence diagnostic code (V15.81) has been available for decades; but, its utility is poorly studied. We examined the association between the V15.81 code assigned prior to the initiation of anti-hypertensive drugs (AHDs) and renal and cardiovascular outcomes. Methods: This was a historical prospective cohort study involving 312,489 newly treated hypertensive individuals (mean age 53.8 years, 90.9% males, 20.3% black, median follow-up 8.0 years). We used crude and Cox models adjusted for baseline socio-demographic characteristics, estimated glomerular filtration rate (eGFR), body mass index, blood pressure, comorbidities, and prospective AHD adherence (measured as proportion of days covered, PDC). Results: In the unadjusted analysis, the V15.81 code was associated with higher risks for faster eGFR decline (hazard ratio, HR 1.22, 95% CI 1.11-1.33), incident CKD (HR 1.17, 95% CI 1.09-1.27), end-stage renal disease (ESRD) (HR 2.53, 95% CI 1.72-3.72), incident coronary artery disease (CAD) (HR 1.26, 95% CI 1.15-1.38), and stroke (HR 1.55, 95% CI 1.38-1.73). In the adjusted model, the V15.81 code remained predictive of increased risk of CKD (HR 1.33, 95% CI 1.22-1.45), ESRD (HR 1.81, 95% CI 1.18-2.78), incident CAD (HR 1.26, 95% CI 1.14-1.40), and stroke (HR 1.46, 95% CI 1.29-1.65). Additional adjustment for PDC did not alter adverse associations between V15.81 code and studied outcomes. Conclusions: Assignment of V15.81 code prior to AHD therapy was associated with higher risks of renal and cardiovascular outcomes in incident hypertensive US veterans. Previous history of non-adherence is a poor prognostic marker in hypertensive individuals; therefore, patients with V15.81 code may require close monitoring. The observational nature of this study limits our ability to make firm recommendations for clinical practice.

Original languageEnglish
Pages (from-to)151-157
Number of pages7
JournalAmerican Journal of Nephrology
Issue number2
Publication statusPublished - Oct 16 2015



  • Chronic kidney disease
  • Coronary artery disease
  • End-stage renal disease
  • Non-adherence
  • Stroke
  • V15.81 code

ASJC Scopus subject areas

  • Nephrology

Cite this

Gosmanova, E. O., Molnar, M. Z., Alrifai, A., Lu, J. L., Streja, E., Cushman, W. C., Kalantar-Zadeh, K., & Kovesdy, C. P. (2015). Impact of Non-Adherence on Renal and Cardiovascular Outcomes in US Veterans. American Journal of Nephrology, 42(2), 151-157.