{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T04:56:10Z","timestamp":1790571370915,"version":"4.1.0"},"reference-count":40,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T00:00:00Z","timestamp":1790553600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Medication discrepancy reflects an observed mismatch between a prescribed medication regimen and actual medication use and is conceptually distinct from medication nonadherence or medication error. We estimated the prevalence of medication discrepancy in maintenance hemodialysis (MHD) patients and developed a development-stage nomogram for identifying prevalent medication discrepancy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This multicenter cross-sectional study included 328 MHD patients from four tertiary-hospital hemodialysis centers in Guangdong Province, China, between December 2022 and May 2023. Medication discrepancy was ascertained with an order-referenced medication-reconciliation process based on the modified Medication Discrepancy Tool. The primary model included three predictor domains with complete data: residential area, monthly income, and the Beliefs about Medicines Questionnaire (BMQ) total score, represented by five model parameters after categorical coding and spline transformation. BMQ was modeled continuously with a three-knot restricted cubic spline. Model performance was evaluated using 1,000-resample bootstrap optimism correction and leave-one-center-out internal-external validation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Medication discrepancy was identified in 256 of 328 participants (78.05%). BMQ showed an overall nonlinear association with prevalent medication discrepancy (global\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&amp;lt;\u20090.001; test for nonlinearity\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.011). In the primary model, urban residence had an odds ratio (OR) of 1.93 (95% CI 0.99\u20133.75;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.053) versus rural residence, while monthly income &amp;gt;5,000 CNY had an OR of 0.33 (95% CI 0.15\u20130.73;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.006) versus &amp;lt;3,000 CNY. The apparent AUC was 0.723 (95% CI 0.663\u20130.783) and the bootstrap optimism-corrected AUC was 0.701. Leave-one-center-out validation yielded a pooled AUC of 0.601, Brier score of 0.180, calibration intercept of 0.722, and calibration slope of 0.362, with substantial heterogeneity across centers.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The three-domain nomogram showed moderate apparent discrimination but substantially attenuated and heterogeneous cross-center performance. It should be regarded as a development-stage identification model for prevalent medication discrepancy and requires independent external validation, and potentially recalibration, before clinical use.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1900963","type":"journal-article","created":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T04:28:45Z","timestamp":1790569725000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Development of a nomogram for identifying prevalent medication discrepancy in maintenance hemodialysis patients: a multicenter cross-sectional study"],"prefix":"10.3389","volume":"13","author":[{"given":"Xiaodan","family":"Lin","sequence":"first","affiliation":[{"name":"Department of Nursing, Shantou University Medical College","place":["Shantou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mianzhou","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Shantou Central Hospital","place":["Shantou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhaochuan","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Hemodialysis, The First Affiliated Hospital of Shantou University Medical College","place":["Shantou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yinghua","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Hemodialysis, The First Affiliated Hospital of Shantou University Medical College","place":["Shantou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hao","family":"Guo","sequence":"additional","affiliation":[{"name":"Department of Nursing, Shantou University Medical College","place":["Shantou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Siying","family":"Ouyang","sequence":"additional","affiliation":[{"name":"Department of Nursing, Shantou University Medical College","place":["Shantou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wendi","family":"Shao","sequence":"additional","affiliation":[{"name":"Department of Nursing, Shantou University Medical College","place":["Shantou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shutian","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Hemodialysis, The Second Affiliated Hospital of Shantou University Medical College","place":["Shantou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shihua","family":"Zheng","sequence":"additional","affiliation":[{"name":"Department of Hemodialysis, Shantou Chaonan Minsheng Hospital","place":["Shantou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yancao","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Hemodialysis, The First Affiliated Hospital of Shantou University Medical College","place":["Shantou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,28]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"1294","DOI":"10.1001\/jama.2019.14745","article-title":"Chronic kidney disease diagnosis and management: a review","volume":"322","author":"Chen","year":"2019","journal-title":"JAMA"},{"key":"B2","doi-asserted-by":"publisher","first-page":"902","DOI":"10.3760\/cma.j.cn112138-20221013-00755","article-title":"Guidelines for the early evaluation and management of chronic kidney disease in China","volume":"62","year":"2023","journal-title":"Chin J Intern Med"},{"key":"B3","doi-asserted-by":"publisher","first-page":"586","DOI":"10.1111\/jocn.13588","article-title":"Medication-taking behaviors in chronic kidney disease with multiple chronic conditions: a meta-ethnographic synthesis of qualitative studies","volume":"26","author":"Bartlett Ellis","year":"2017","journal-title":"J Clin Nurs"},{"key":"B4","doi-asserted-by":"publisher","first-page":"919","DOI":"10.1159\/000520028","article-title":"Medication burden and prescribing patterns in patients on hemodialysis in the USA, 2013\u20132017","volume":"52","author":"Paik","year":"2021","journal-title":"Am J Nephrol"},{"key":"B5","doi-asserted-by":"publisher","first-page":"741","DOI":"10.1007\/s40266-023-01039-z","article-title":"Association of potentially inappropriate medication classes with mortality risk among older adults initiating hemodialysis","volume":"40","author":"Hall","year":"2023","journal-title":"Drugs Aging"},{"key":"B6","year":"2022"},{"key":"B7","year":""},{"key":"B8","doi-asserted-by":"publisher","first-page":"e0144119","DOI":"10.1371\/journal.pone.0144119","article-title":"Nonadherence to medication therapy in haemodialysis patients: a systematic review","volume":"10","author":"Ghimire","year":"2015","journal-title":"PLoS One"},{"key":"B9","doi-asserted-by":"publisher","first-page":"15266","DOI":"10.3390\/ijerph192215266","article-title":"Assessment of health-related quality of life, medication adherence, and prevalence of depression in kidney failure patients","volume":"19","author":"Butt","year":"2022","journal-title":"Int J Environ Res Public Health"},{"key":"B10","doi-asserted-by":"publisher","first-page":"e934482","DOI":"10.12659\/MSM.934482","article-title":"Development of a predictive nomogram for estimating medication nonadherence in hemodialysis patients","volume":"28","author":"Wang","year":"2022","journal-title":"Med Sci Monit"},{"key":"B11","doi-asserted-by":"publisher","first-page":"111385","DOI":"10.1016\/j.jpsychores.2023.111385","article-title":"Development and validation of a nomogram model for medication non-adherence in patients with chronic kidney disease","volume":"171","author":"Wu","year":"2023","journal-title":"J Psychosom Res"},{"key":"B12","doi-asserted-by":"publisher","first-page":"453","DOI":"10.3760\/cma.j.cn441217-20210819-00067","article-title":"Guidelines for early screening, diagnosis, prevention and treatment of chronic kidney disease (2022 edition)","volume":"38","year":"2022","journal-title":"Chin J Nephrol"},{"key":"B13","doi-asserted-by":"publisher","first-page":"627","DOI":"10.1016\/j.jclinepi.2014.12.014","article-title":"The number of subjects per variable required in linear regression analyses","volume":"68","author":"Austin","year":"2015","journal-title":"J Clin Epidemiol"},{"key":"B14","doi-asserted-by":"publisher","first-page":"4460","DOI":"10.6039\/j.issn.1001-0408.2015.31.45","article-title":"Reliability and validity evaluation of modified medication discrepancy tool","volume":"26","author":"Wang","year":"2015","journal-title":"Chin Pharm"},{"key":"B15","doi-asserted-by":"publisher","first-page":"389","DOI":"10.3761\/j.issn.0254-1769.2014.04.001","article-title":"Reliability and validity of the Chinese version of the beliefs about medicines questionnaire among elderly patients with depression","volume":"49","author":"Lu","year":"2014","journal-title":"Chin J Nursing"},{"key":"B16","doi-asserted-by":"publisher","first-page":"193","DOI":"10.1016\/0165-1781(89)90047-4","article-title":"The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research","volume":"28","author":"Buysse","year":"1989","journal-title":"Psychiatry Res"},{"key":"B17","doi-asserted-by":"publisher","first-page":"1680","DOI":"10.1016\/S0140-6736(17)31047-4","article-title":"Medication without harm: WHO\u2019s third global patient safety challenge","volume":"389","author":"Donaldson","year":"2017","journal-title":"Lancet"},{"key":"B18","doi-asserted-by":"publisher","first-page":"678","DOI":"10.1016\/j.jsps.2023.03.008","article-title":"Pill-burden and its association with treatment burden among patients with advanced stages of chronic kidney disease","volume":"31","author":"Al-mansouri","year":"2023","journal-title":"Saudi Pharm J"},{"key":"B19","doi-asserted-by":"publisher","first-page":"1603","DOI":"10.1213\/ANE.0000000000005362","article-title":"Developing a clinical prediction score: comparing prediction accuracy of integer scores to statistical regression models","volume":"132","author":"Subramanian","year":"2021","journal-title":"Anesth Analg"},{"key":"B20","doi-asserted-by":"publisher","first-page":"54","DOI":"10.1016\/j.jpsychores.2019.03.184","article-title":"Utilization of the beliefs about medicine questionnaire and prediction of medication adherence in China: a systematic review and meta-analysis","volume":"122","author":"Nie","year":"2019","journal-title":"J Psychosom Res"},{"key":"B21","doi-asserted-by":"publisher","first-page":"578","DOI":"10.1080\/17437199.2022.2127831","article-title":"Can temporal self-regulation theory and its constructs predict medication adherence? A systematic review and meta-analysis","volume":"17","author":"Liddelow","year":"2023","journal-title":"Health Psychol Rev"},{"key":"B22","doi-asserted-by":"publisher","first-page":"174","DOI":"10.1186\/s12882-023-03231-0","article-title":"Determinants of medication adherence in hemodialysis patients: a cross-sectional study based on capability-opportunity-motivation and behavior model","volume":"24","author":"Mirzaei-Alavijeh","year":"2023","journal-title":"BMC Nephrol"},{"key":"B23","doi-asserted-by":"publisher","first-page":"554","DOI":"10.1186\/s13104-018-3668-z","article-title":"Magnitude and factors associated with medication discrepancies identified through medication reconciliation at care transitions of a tertiary hospital in Eastern Ethiopia","volume":"11","author":"Tamiru","year":"2018","journal-title":"BMC Res Notes"},{"key":"B24","doi-asserted-by":"publisher","first-page":"1169","DOI":"10.1007\/s11096-022-01453-0","article-title":"The role of clinical pharmacist in enhancing hemodialysis patients\u2019 adherence and clinical outcomes: a randomized-controlled study","volume":"44","author":"Alshogran","year":"2022","journal-title":"Int J Clin Pharm"},{"key":"B25","doi-asserted-by":"publisher","first-page":"e0263412","DOI":"10.1371\/journal.pone.0263412","article-title":"Study protocol: effectiveness of patient centered pharmacist care in improving medication adherence, clinical parameters and quality of life among hemodialysis patients","volume":"17","author":"Paneerselvam","year":"2022","journal-title":"PLoS One"},{"key":"B26","doi-asserted-by":"publisher","first-page":"307","DOI":"10.1186\/s12882-023-03346-4","article-title":"Prevalence, associated factors and clinical implications of medication literacy linked to frailty in hemodialysis patients in China: a cross-sectional study","volume":"24","author":"Zhu","year":"2023","journal-title":"BMC Nephrol"},{"key":"B27","doi-asserted-by":"publisher","first-page":"e026582","DOI":"10.1161\/JAHA.122.026582","article-title":"Global burden, regional differences, trends, and health consequences of medication nonadherence for hypertension during 2010 to 2020: a meta-analysis involving 27 million patients","volume":"11","author":"Lee","year":"2022","journal-title":"J Am Heart Assoc"},{"key":"B28","doi-asserted-by":"publisher","first-page":"1334","DOI":"10.1007\/s10903-019-00867-9","article-title":"Factors impacting adherence to diabetes medication among urban, low-income Mexican-Americans with diabetes","volume":"21","author":"Baghikar","year":"2019","journal-title":"J Immigr Minor Health"},{"key":"B29","doi-asserted-by":"publisher","first-page":"2129","DOI":"10.1016\/S0140-6736(22)00532-3","article-title":"Measuring the availability of human resources for health and its relationship to universal health coverage for 204 countries and territories from 1990 to 2019: a systematic analysis for the Global Burden of Disease Study 2019","volume":"399","year":"2022","journal-title":"Lancet"},{"key":"B30","doi-asserted-by":"publisher","first-page":"191","DOI":"10.1186\/s12939-022-01804-3","article-title":"The economics of healthcare access: a scoping review on the economic impact of healthcare access for vulnerable urban populations in low- and middle-income countries","volume":"21","author":"de Siqueira Filha","year":"2022","journal-title":"Int J Equity Health"},{"key":"B31","doi-asserted-by":"publisher","first-page":"e0001467","DOI":"10.1371\/journal.pgph.0001467","article-title":"National health policies and strategies for addressing chronic kidney disease: data from the International Society of Nephrology Global Kidney Health Atlas","volume":"3","author":"Neuen","year":"2023","journal-title":"PLOS Glob Public Health"},{"key":"B32","doi-asserted-by":"publisher","first-page":"e047245","DOI":"10.1136\/bmjopen-2020-047245","article-title":"Current status of health systems financing and oversight for end-stage kidney disease care: a cross-sectional global survey","volume":"11","author":"Yeung","year":"2021","journal-title":"BMJ Open"},{"key":"B33","doi-asserted-by":"publisher","first-page":"136","DOI":"10.1159\/000516075","article-title":"Prevalence of polypharmacy and risks of potentially inappropriate medication use in the older population in a developing country: a systematic review and meta-analysis","volume":"68","author":"Bhagavathula","year":"2022","journal-title":"Gerontology"},{"key":"B34","doi-asserted-by":"publisher","first-page":"519","DOI":"10.5414\/CP203951","article-title":"Patterns of drug use and polypharmacy burden in chronic kidney disease patients: an experience from a secondary care hospital in United Arab Emirates","volume":"59","author":"Shouqair","year":"2021","journal-title":"Int J Clin Pharmacol Ther"},{"key":"B35","doi-asserted-by":"publisher","first-page":"11","DOI":"10.1111\/jan.15776","article-title":"Medication adherence trajectory of patients with chronic diseases and its influencing factors: a systematic review","volume":"80","author":"Chen","year":"2024","journal-title":"J Adv Nurs"},{"key":"B36","doi-asserted-by":"publisher","first-page":"CD012625","DOI":"10.1002\/14651858.CD012625.pub2","article-title":"Interventions for improving sleep quality in people with chronic kidney disease","volume":"5","author":"Natale","year":"2019","journal-title":"Cochrane Database Syst Rev"},{"key":"B37","doi-asserted-by":"publisher","first-page":"786","DOI":"10.1016\/S0140-6736(21)00519-5","article-title":"Chronic kidney disease","volume":"398","author":"Kalantar-Zadeh","year":"2021","journal-title":"Lancet"},{"key":"B38","doi-asserted-by":"publisher","first-page":"108392","DOI":"10.1016\/j.diabres.2020.108392","article-title":"White coat adherence effect on glucose control in adult individuals with diabetes","volume":"168","author":"Zueger","year":"2020","journal-title":"Diabetes Res Clin Pract"},{"key":"B39","doi-asserted-by":"publisher","first-page":"e078378","DOI":"10.1136\/bmj-2023-078378","article-title":"TRIPOD+AI statement: updated guidance for reporting clinical prediction models that use regression or machine learning methods","volume":"385","author":"Collins","year":"2024","journal-title":"Br Med J"},{"key":"B40","doi-asserted-by":"publisher","first-page":"e071018","DOI":"10.1136\/bmj-2022-071018","article-title":"Transparent reporting of multivariable prediction models developed or validated using clustered data: TRIPOD-cluster checklist","volume":"380","author":"Debray","year":"2023","journal-title":"Br Med J"}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1900963\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T04:28:50Z","timestamp":1790569730000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1900963\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,28]]},"references-count":40,"alternative-id":["10.3389\/fmed.2026.1900963"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2026.1900963","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,28]]},"article-number":"1900963"}}