Evaluation of tools for annual capture of adherence to immunosuppressive medications after renal transplantation - a single-centre open prospective trial

Abstract

Summary Annual assessment of adherence would strengthen long‐term outcome assessments from registry data. The objective of this study was to evaluate tools suitable for annual routine capture of adherence data in renal transplant recipients. A single‐centre open prospective trial included 295 renal transplant recipients on tacrolimus. Two‐thirds of the patients were included 4 weeks post‐transplant, randomized 1:1 to intensive or single‐point adherence assessment in the early phase and 1‐year post‐transplant. One‐third were included 1‐year post‐transplant during a cross‐sectional investigation. Adherence was assessed using multiple methods: The “Basel Assessment of Adherence to Immunosuppressive Medication Scale” (BAASIS©) questionnaire was used to assess self‐reported adherence. The treating clinician scored patient′s adherence and tacrolimus trough‐concentration variability was calculated. In the analyses, the data from the different tools were dichotomized (adherent/nonadherent). The BAASIS© overall response rate was over 80%. Intensive BAASIS© assessment early after transplantation increased the chance of capturing a nonadherence event, but did not influence the 1‐year adherence prevalence. The adherence tools generally captured different populations. Combining the tools, the nonadherence prevalence at 1 year was 38%. The different tools identified to a large degree different patients as nonadherent. Combining these tools is feasible for annual capture of adherence status.

Identifying Core Variables Associated With Health Literacy in Kidney Transplant Recipients

“…Gathering information and acquiring knowledge is only a small part of managing chronic disease. The results of the Norwegian non-adherence study, mentioned above, also support these findings: although kidney transplant recipients followed a comprehensive patient education program over 8 weeks, non-adherence increased from 9% to 32% in 1 year (59). This underscores our need to have a more complex understanding of patients' behaviors and needs related to health.…”

“…Non-adherence has been found to be the third leading cause of kidney graft losses (58), and reducing non-adherence to a minimum is therefore one of the major ambitions in kidney transplant care. A recent Norwegian study revealed that 9% of kidney transplant recipients were non-adherent to medications eight weeks post-transplantation, and that the prevalence increased to at least 32% within the first year, depending on the type of tool that was used (59). Studies investigating adherence to lifestyle recommendations and graft monitoring indicate that patients are less adherent in these areas compared to medication adherence (60,61).…”

Tacrolimus intrapatient variability in solid organ transplantation: A multiorgan perspective

“…Retrospective studies utilizing physician records, patient report, or clinic nonattendance to define MNA have not consistently supported a relationship between MNA and IPV 15,28,50,53 . Conflicting results have also been observed among prospective studies assessing MNA using electronic monitoring or rigorous multimodal approaches 65,73,80–82 . Although some discordance may be related to data quality pertaining to the method(s) of defining MNA or small patient population, clinicians must evaluate IPV in a patient‐specific context, including all other possible sources of IPV.…”

Blood Pressure Treatment in Kidney Transplant Recipients—Can We Improve?

“…In KTx recipients, a degree of nonadherence towards immunosuppressive medication is reported to be in the range of 30%-35% and similar findings are likely for antihypertensive medication. 25 Several factors can contribute to nonadherence; hypertension is asymptomatic and medication has side effects, low health literacy, polypharmacy, forgetfulness, and poor physician-patient relationship (including the failure to consider nonadherence). 26 Low adherence was, however, only reported for 4% in the Surv resp group, which we believe reflects underreporting by the treating physicians.…”