Medication Compliance After Renal Transplantation

Abstract

Please be advised that this information was generated on 2018-05-10 and may be subject to change. TRANSPLANTATIONVol MEDICATION COMPLIANCE AFTER RENAL TRANSPLANTATION1 L u k a s B. H ilb r a n d s ,2 A n d r ie s J. H o itsm a , a n d R o b e r t A.P. K o e n e Department ofMedicine} Division of Nephrology, University Hospital Nijmegen, NL-6500 HB Nijmegen, The NetherlandsNoncompliance is known to be an important cause of late graft failure after renal transplantation. We inves tigated prospectively the degree of compliance with immunosuppressive and antihypertensive drugs dur ing the first year after renal transplantation by monthly pill counts. In addition, we examined whether noncompliance was related to a number of demographic and clinical variables or to the occur rence of rejections. The study population consisted of 127 patients who were involved in a randomized trial comparing cyclosporine monotherapy with azathioprine-prednisone treatment. Average compliance rates approximated 100%, although considerable vari ability within and between subjects was observed. Us ing an arbitrary lim it to classify patients as compliers or noncompliers, the following frequencies of noncom pliance were observed during the study year: cyclo sporine, 23%; azathioprine, 13%; prednisone, 23%; atenolol, 36%; and nifedipine, 32%. Average compli ance scores for all im m unosuppressive drugs were su perior to those of antihypertensive m edication (P< 0.001). Except for a better com pliance for pred nisone in men as compared w ith wom en, w e found no consistent relationship betw een com pliance on the one hand and several dem ographic variables, graft function, or quality of life on the other hand. Patients who developed one or more acute rejection episodes showed a higher degree of under com pliance, espe cially for prednisone, than patients w ithout rejections (P<0.01). Following the occurrence of a rejection epi sode, compliance scores im proved significantly.Keeping in mind the lim itations of the p ill count method, we conclude that noncom pliance w ith immu nosuppressive drugs is not a huge problem during the first year after renal transplantation. H ow ever, it is likely that noncom pliance contributes to a certain number of acute rejection episodes.Noncompliance with the therapeutic regimen is considered to be a major cause of graft failure after (organ) transplan tation (1-5). Accordingly* efforts to encourage adherence to the medical regimen are regarded as an important aspect of posttransplant patient management (4,5). However, detailed data on the extent of medication noncompliance and on fac tors associated with it in renal transplant patients are scarcely available.We examined medication compliance during the first year after renal transplantation by use of the pill count method, looking for an answer to the following questions: (1) What is the extent of noncompliance with immunosuppressive and antihypertensive drugs after renal transplantation? (2) Can the level of noncompliance be predicted from demographic or cli...

Frequency and impact of nonadherence to immunosuppressants after renal transplantation: a systematic review

“…Standardized definitions were related to the quantity and frequency of missed medication or TRANSPLANTATION delays in taking tablets and were assessed by questionnaire (14 -17), interview (2,18), pill counts (19), pharmacy refill data (20), cyclosporine levels (21), or electronic monitoring (10). Nine of the remaining 20 cohort studies and case series attempted a definition, but these were nonstandardized statements such as "a definite history" of nonadherence (22) or "graft loss thought to be due" to nonadherence (9).…”

“…Taking medication 2 or 2.5 hr late at least once per month (14,18) has also been used to define nonadherence. Three studies have used a defined percentage of missed doses: Nevins and colleagues (10) and Hilbrands and colleagues (19) used missing at least 10% of doses, and Chisholm and colleagues (20) used missing at least 20% of doses. These percentages correspond to missing three or six doses per month, respectively, assuming daily dosing.…”

“…There was more uniformity among the cross-sectional studies using similar definitions. The frequency of nonadherence was found to be between 17% and 26% of subjects in all but one (24) of the cross-sectional studies defining nonadherence as missing, forgetting, or altering a dose of medication at least once per month (9, 14 -18); forgetting or missing immunosuppressants more often than "never" (17, 24 -26); or missing at least 10% of medication doses (10,19). Both studies using electronic monitoring (10, 13) reported a continuous description of nonadherence.…”

Symptom experience after solid organ transplantation

“…Some studies have shown that side-effects of immunosuppressive drugs may affect HRQoL as perceived by the patient, resulting in varying rates of nonadherence [13,14,24,[52][53][54][55]. Chisholm [53] investigated patients' responses to cyclosporine-versus tacrolimus-related side-effects in terms of nonadherence behavior and found that significantly more patients were nonadherent when treated with cyclosporine-based antirejection regimens.…”

“…These findings suggest that patients have very concrete beliefs about the "effectiveness" of their particular immunosuppressive drugs and on the quantity of medications that is needed to protect the organ successfully from risking organ loss resulting from organ rejection. Corticosteroids as part of the immunosuppressive regimen have side-effects that lead to serious symptom experiences and subsequently to nonadherence [14,54]. Withdrawing or minimizing corticosteroids may minimize these side-effects [46] and reduce the risk of nonadherence.…”