Assessing associations between medication adherence and potentially modifiable psychosocial variables in pediatric kidney transplant recipients and their families

Abstract

Post-transplant immunosuppressant (IS) medication adherence is essential for long-term graft survival and relatively little is known about psychosocial barriers that interfere with optimum medication adherence in pediatric kidney transplant patients. The objective of this prospective observational cohort study was to assess the impact of modifiable psychosocial variables on medication adherence. Our hypothesis was that parental stress, dysfunctional parent-child interactions and child behavior problems would be associated with poorer medication adherence. Thirteen pediatric kidney transplant patients and their caregivers were enrolled. Transplant recipients who were able to read and caregivers of all the transplant recipients completed behavioral and attitudinal surveys. A subgroup of seven families dispensed their primary IS medication from an electronic monitoring vial (MEMS Smart Cap). For these patients, medication adherence was calculated by computing a ratio of the medication taken divided by the prescribed dose. In addition, for the entire group, serial IS levels were reviewed by two board certified pediatric nephrologists who categorized all 13 transplant recipient families as either 'probably adherent (PA)' or 'possibly non-adherent (PNA)'. Pearson correlation coefficients and independent samples Student t-tests were used to assess the association between medication adherence and psychosocial variables measured by standardized questionnaires. In this study, elevated parental stress, dysfunctional parent-child interactions, and child behavior problems were associated with poorer medication adherence. In addition, we found evidence to support the relationship between subjective dissatisfaction with appearance and poorer medication adherence. These findings suggest that pre-transplant recipient evaluations of risk factors for poor adherence are warranted.

Parenting Stress of Low-Income Parents of Toddlers and Preschoolers: Psychometric Properties of a Short Form of the Parenting Stress Index

“…Furthermore, from a clinical perspective the refinement and clarification of the elements that contribute to parenting stress may be helpful to the practitioner who is interested in specifically targeting issues for intervention or identifying families at risk of dropping out. For example, although compliance with medical and behavioral treatment for children has been shown 52 WHITESIDE-MANSELL ET AL. to be related to parenting stress (Gerson, Furth, Neu, & Fivush, 2004;Kazdin, Mazurick, & Bass, 1993), it is not clear what aspect of stress is most critical. From a program development point of view, clarification of the components of parenting and its stressors may help assist in defining and refining program goals and objectives.…”

Oral Session: Transplant Potpourri

“…CONCLUSION: Up to 25% of BKPyVAN develop later than two years after KTx, possibly as a consequence of a reduced BKPyV-specific cellular immune response of pediatric patients. 4 Hence, in pediatric kidney allograft recipients, surveillance for BKPyV viremia should be extended beyond the 2nd year posttransplant. REFERENCES: …”

“…Risk factors associated with nonadherence include emotional and behavioral problems (Maikranz et al, 2007), poor healthrelated quality of life (Devine et al, 2011), parental stress and parent-child relationship (Gerson et al, 2004). There is also an association between psychosocial risk factors pretransplant and outcomes posttransplant (Vanderlann et al, 2015).…”

Transtornos mentais e qualidade de vida em crianças e adolescentes com doença renal crônica e em seus cuidadores

“…9 Another point to be considered is the association between the worsening in the QoL and the morbimortality of CKD patients. 34,35 QoL is a multidisciplinary concept that consists in the perception of the individual of his/her position in life, in the context of the culture and system of values in which he/she lives and in relation to his/her objectives, expectations, standards and concerns. QoL worsening interferes with the prognosis of these patients.…”