Medication adherence patterns in adult renal transplant recipients

Abstract

Patient adherence to immunosuppressive medications adherence is crucial to survival of the patient and a transplanted kidney, yet adherence is variable. Using a prospective, descriptive design, immunosuppressive medication adherence of 44 renal transplant recipients was followed for 6 months at a Midwestern transplant center using electronic monitoring. Four medication adherence patterns emerged from a hierarchical cluster analysis: those who took medications on time, those who took medications on time with late/missed doses, those who rarely took medications on time and who were late with morning and/or evening doses, and those who missed doses. This study is a step toward developing and implementing interventions targeted to specific patterns of poor adherence.

Psychosocial Predictors of Mortality Following Lung Transplantation

“…Although many lung transplant recipients experience improved physical quality of life, psychological aspects of quality life appear to remain impaired in many patients (32). Psychological difficulties are an important factor in posttransplant management, as they have been shown to predict medication adherence in other populations (12,33–35), which is a crucial aspect of posttransplant survival (36,37). Results from the present study suggest that screening for depressive symptoms following transplantation may be important for the identification and treatment of posttransplant patients with elevated levels of distress.…”

Quantifying the impact of nonadherence patterns on exposure to oral immunosuppressants

“…The adherence model was developed to mimic the 16 nonadherence patterns described by Russell et al9 This adherence model was coupled to a previously published population pharmacokinetic (dose-exposure) model that describes the within- and between-individual variability in the concentration-time profile of cyclosporine 3. The coupled simulation model was applied to determine variability in two measures of exposure: C avg and C min .…”

“…The dose of cyclosporine assigned to each subject was adjusted such that the steady-state C min value for the subject was within the widely accepted therapeutic window of 100–200 ng/mL for immunosuppression maintenance. Second, the drug adherence model was applied to simulate a sequence of doses for each of the 500 subjects over a period of 90 days, based upon the relative frequency of the adherence patterns reported by Russell et al9 Third, the population pharmacokinetic model was used to simulate C avg and C min values for each dose in a sequence for each of the 500 subjects. The variability in the values of C avg and C min were then summarized and reported.…”

“…Studies using the Medication Event Monitoring System (MEMS) find that patients’ medication-taking behavior comprises a variety of complex patterns that cannot clearly be dichotomized into adherent and nonadherent 9. Russell et al used MEMS to study adult kidney transplant recipients taking an oral immunosuppressant twice daily at prescribed times, 12 hours apart, in the morning and evening 9.…”

“…Russell et al used MEMS to study adult kidney transplant recipients taking an oral immunosuppressant twice daily at prescribed times, 12 hours apart, in the morning and evening 9. At each dosing, one of four possibilities could occur: the dose could be taken early, on time, late, or could be missed.…”