Diagnostic Accuracy of Measurement Methods to Assess Non-Adherence to Immunosuppressive Drugs in Kidney Transplant Recipients

Schäfer-Keller, Petra; Steiger, Jürg; Böck, Andreas; Denhaerynck, Kris; Geest, Sabina De

doi:10.1111/j.1600-6143.2007.02127.x

Cited by 183 publications

(210 citation statements)

References 55 publications

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“…Furthermore, the cost of using medication adherence monitors can be prohibitive and there is debate over their effi cacy and safety. 32 Future trials should attempt to collect data longitudinally, as patients may have different adherence rates over time.…”

Section: Discussionmentioning

confidence: 99%

Barriers to immunosuppressive medication adherence in high‐risk adult renal transplant recipients

Constantiner

Cukor

2011

Dialysis & Transplantation

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BACKGROUNDNon‐adherence to immunosuppressive medication in renal transplant recipients is a primary cause of kidney rejection. However, little is known about the reasons transplant patients are non‐adherent. We report on the specific barriers to medication adherence in 94 kidney transplant recipients from a medical center in Brooklyn, New York.METHODSTransplant patients waiting for their monthly medical appointment completed questionnaires relating to their adherence, level of depression, barriers to medication taking, and beliefs in their abilities to take their medication as prescribed.RESULTSThe particular barriers that were most associated with lower levels of adherence were too many doses per day, too many pills per dose, having to remember to take medication, perceived side effects of medication, skipping a dose to feel good, falling out of a daily routine, and being short of money. The overall level of barriers that the sample endorsed was associated with increased depression (r = 0.209, p = 0.049) and decreased medi‐cation self‐efficacy (r = −0.300, p = 0.004). An elevation in the “unintentional” factor of the barriers scale was significantly associated with depression (r = 0.211, p = 0.046), but not directly with adherence. The “deliberate” factor was associated with non‐adherence (r = −0.21, p < 0.05) but not depression (r = 0.173, p > 0.05)CONCLUSIONSThere may be two reasons transplant recipients are non‐adherent to prescribed medications. One set of barriers is related to deliberately choosing to skip doses, and the other set is related to inadvertent or uncontrollable situations. Interventions designed to promote adherence in this population should address both pathways. Dial. Transplant. © 2011 Wiley Periodicals, Inc.

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Section: Discussionmentioning

confidence: 99%

Barriers to immunosuppressive medication adherence in high‐risk adult renal transplant recipients

Constantiner

Cukor

2011

Dialysis & Transplantation

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“…Contudo, sugere-se que, para uma melhor verificação, seja utilizado mais de um método [14,15]. A avaliação da adesão pode ser caracterizada como direta, por exemplo: observação direta da administração dos medicamentos ou níveis de concentração das drogas; e indireta, por relato familiar ou monitoramento eletrônico [16].…”

Section: Introductionunclassified

Avaliação da adesão à terapia imunossupressora por autorrelato de pacientes submetidos ao transplante renal

Rocha

Figueiredo

Canabarro

et al. 2017

Sci Med

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Este artigo está licenciado sob forma de uma licença Creative Commons Atribuição 4.0 Internacional, que permite uso irrestrito, distribuição e reprodução em qualquer meio, desde que a publicação original seja corretamente citada. ABSTRACT AIMS: To evaluate the characteristics and risk factors related to the adherence to immunosuppressive treatment of renal transplant patients using the self-report method by means of the Basel Assessment of Adherence Scale for Immunosuppressives (BAASIS). METHODS: A prospective cohort study with a quantitative approach was performed at the Nephrology and Transplantation Service of São Lucas Hospital of the Pontifical Catholic University of Rio Grande do Sul, with patients older than 18 years, transplanted from kidneys from deceased or living donors, with a minimum transplant time of three months and a maximum of 12 months. The BAASIS instrument was applied to evaluate adhesion. For statistical analysis, Fisher exact test (Monte Carlo simulation) was used to verify the association between the categorical variables, Student t test for independent sample means and Mann Whitney test in the variables without normality. A p<0.05 was adopted for the results to be considered significant. RESULTS: The sample consisted of 59 patients, 57.6% of whom were male, 79.7% were white, the mean age was 45.8 years, 57.6% had elementary school and 72.9% were catholic. Hemodialysis was the most used method, in 86.4% of patients before transplantation, and the mean time in the waiting list was 19.5 months. After transplantation, the mean time of hospitalization was 17.2 days. The assessment of adherence by BAASIS characterized 83% of patients as non-adherent. The main fact considered as non-adherence was to take the immunosuppressive drugs with more than two hours difference from the prescribed time, at least once a week, in the last four weeks. There was no significant difference when the statistical analysis was performed to compare the adhesion rate among the various categories of the demographic and clinical variables of the patients. CONCLUSIONS: A high rate of patients not adherent to the immunosuppressive treatment was identified, and the change in the schedule of immunosuppressants was the main fact that characterized this behavior. A shorter waiting time in the transplant queue was associated with non-adherence. The other variables, demographic and clinical, were not associated to the classification of adherent or non-adherent.

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“…In the absence of sophisticated methods for assessing nonadherence in daily clinical practice, such as electronic monitoring, it is advisable to combine all the information from available sources, such as self-reports, collateral reports, pharmacy refill data and/or assays, 80,81 to determine at each clinical encounter whether patients are experiencing issues with nonadherence. 12 Once patients at risk of medication nonadherence are identified, they can be targeted for more intensive, tailored interventions.…”

Section: Strategies For Managing Nonadherencementioning

confidence: 99%

“…86 In summary, a combination of different interventions may be the most effective strategy in enhancing patient self-management and adherence to medication, and ultimately improving outcomes posttransplant. 80 Recommendations for Managing Nonadherence in Kidney Transplantation In solid organ transplantation, constant and controlled exposure to immunosuppression provides protection against the development of cellular and antibody-mediated rejection (AMR) and graft loss, while minimizing drug-related toxicity. Nowadays, the cornerstones of immunosuppression protocols, both in kidney and liver transplantation, are CNIs, particularly tacrolimus, which is superior to cyclosporine in the prevention of T cell-mediated rejection (TCMR) and graft loss.…”

Section: Strategies For Managing Nonadherencementioning

confidence: 99%

Practical Recommendations for Long-term Management of Modifiable Risks in Kidney and Liver Transplant Recipients

et al. 2017

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Short-term patient and graft outcomes continue to improve after kidney and liver transplantation, with 1-year survival rates over 80%; however, improving longer-term outcomes remains a challenge. Improving the function of grafts and health of recipients would not only enhance quality and length of life, but would also reduce the need for retransplantation, and thus increase the number of organs available for transplant. The clinical transplant community needs to identify and manage those patient modifiable factors, to decrease the risk of graft failure, and improve longer-term outcomes. COMMIT was formed in 2015 and is composed of 20 leading kidney and liver transplant specialists from 9 countries across Europe. The group's remit is to provide expert guidance for the long-term management of kidney and liver transplant patients, with the aim of improving outcomes by minimizing modifiable risks associated with poor graft and patient survival posttransplant. The objective of this supplement is to provide specific, practical recommendations, through the discussion of current evidence and best practice, for the management of modifiable risks in those kidney and liver transplant patients who have survived the first postoperative year. In addition, the provision of a checklist increases the clinical utility and accessibility of these recommendations, by offering a systematic and efficient way to implement screening and monitoring of modifiable risks in the clinical setting. 12 Department of Gastroenterology and Hepatology, Erasmus MC, University Hospital Rotterdam, the Netherlands. 13 Department of Gastroenterology and Hepatology, University Hospitals KU Leuven, Belgium.14 Abdominal Transplant Surgery, Microbiology and Immunology Department, University Hospitals KU Leuven, Belgium. 15 Department of Hepatology and Liver Transplantation, Reina Sofía University Hospital, IMIBIC, CIBERehd, Spain. www.transplantjournal.com S1 S olid organ transplantation has evolved from an experimental procedure to an established treatment option for many types of end-stage organ failure. Both patient and graft outcomes are continuing to improve, and 1-year patient and graft survival currently exceed 80%.1,2 However, survival rates gradually decline over the long term. In kidney transplant, 5-and 10-year graft survival rates in Europe are 77% and 56%, and for liver transplant, 64% and 54% (Figures 1 and 2). 3,4 Although most European countries have seen an increase in both living and deceased donation, transplantation is not available to all who would benefit from the procedure, and there is considerable morbidity and mortality for those listed for transplant.6 Therefore, maximizing long-term graft survival and reducing the need for retransplantation is paramount, not only in improving outcomes for the recipients but also for those awaiting a graft. The improvement in outcomes is predominantly due to reduction in (Transplantation. 2017;101:S1-S41). The authors were approached by Astellas to discuss the practical implementation o...

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Diagnostic Accuracy of Measurement Methods to Assess Non-Adherence to Immunosuppressive Drugs in Kidney Transplant Recipients

Abstract: Valid assessment of immunosuppressive therapy nonadherence (NAH) is vital: NAH is associated with neg

Cited by 183 publications

References 55 publications

Barriers to immunosuppressive medication adherence in high‐risk adult renal transplant recipients

Barriers to immunosuppressive medication adherence in high‐risk adult renal transplant recipients

Avaliação da adesão à terapia imunossupressora por autorrelato de pacientes submetidos ao transplante renal

Practical Recommendations for Long-term Management of Modifiable Risks in Kidney and Liver Transplant Recipients

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