Mensuração da adesão aos medicamentos imunossupressores em receptores de transplante renal

Abstract

Objective: To measure adherence of renal transplant recipients to immunosuppressive drugs by using the Basel Assessment of Adherence with immunosuppressive medication Scale (BAASIS®) and to describe sociodemographic characteristics and clinical factors in relation to immunosuppressive drugs and creatinine levels. Methods: This retrospective, cross-sectional study was carried out from 2014 to 2015 in the post-transplantation ambulatory unit of the Kidney Hospital and Universidade Federal de São Paulo (UNIFESP). Results: Of the 181 participants, 53.6% were men; recipients ages ranged from 18 to 74 years. Systemic arterial hypertension was the initial diagnosis of chronic renal failure in 38.7% of recipients. About 95% reported that they never forgot to take several consecutive doses of the medicine, 58.6% of recipients reported total adherence to the immunosuppressive drugs, and 41.4% did not adhere to one or more of the four assessed situations. No signifi cant correlation was found between of creatinine levels and total score and by BAASIS® items. Conclusion: A high rate of patients not adherent to the immunosuppressive treatment was identifi ed (41.4%).There was no signifi cant correlation between creatinine level and receptor age at time of KTP, time after KTP, immunosuppressive separation time and total score and scores of individual BAASIS® items. This study showed that black, male recipients without a family support network, obese and autonomous are more likely not to adhere to immunosuppressive therapy. The evaluation of renal transplant recipient adhesion should be considered during all phases of the nursing process actions that make up the therapeutic plan after renal transplantation. ResumoObjetivo: Mensurar a adesão aos medicamentos imunossupressores em receptores de transplante renal, utilizando a Basel Assessment of Adherence with Immunosuppressive Medication Scale -BAASIS ® e descrever as características sociodemográfi cas, os fatores clínicos em relação aos imunossupressores e os níveis de creatinina. Métodos: Estudo prospectivo, transversal, realizado no período de 2014 a 2015, no Ambulatório Pós-Transplante do Hospital do Rim (complexo hospitalar da Universidade Federal de São Paulo (UNIFESP)). Resultados: Dos 181 participantes, 53,6% eram homens e a idade dos receptores variou de 18 a 74 anos. A Hipertensão Arterial Sistêmica foi o diagnóstico inicial de Insufi ciência Renal Crônica em 38,7% dos receptores. Aproximadamente 95% dos receptores relataram que nunca se esqueceram de tomar o medicamento; 58,6% dos pacientes relataram ter aderido totalmente aos imunossupressores e 41,4% não aderiram a uma ou mais das quatro situações avaliadas pelos itens da BAASIS ® . Não foi encontrada correlação signifi cativa pelos itens da BAASIS ® entre os níveis de creatinina e o escore total. Conclusão: Foi identifi cado um alto índice de pacientes que não aderiram ao tratamento imunossupressor (41,4%). Não houve correlação signifi cativa entre o nível de creatinina e a idade do receptor no momento do TxR, bem c...

Feelings, experiences and expectations of kidney transplant individuals and challenges for the nurse

“…In the second category, called "Living with the hemodialysis machine", the statements presented express negative perceptions about being submitted to this modality of treatment and point out similarity with other researches, which highlight changes in the physical, mental and behavioral spheres, as well as in the lifestyle (9,(23)(24) . During the treatment, these people experience several negative nuances, among them the creation of an arteriovenous fistula; double-lumen graft or catheter for the treatment; dependency on a life maintenance machine; feeding restrictions; and restriction of water intake (9) . Other situations, such as dizziness, hypo/hypertension, weakness, weight loss/ gain, anemia, itching, cramp, intestinal constipation, repetitive infections and cardiac arrhythmia, are described in the literature as regular clinical intercurrences (20,(24)(25) .…”

“…The purpose of kidney transplant is to improve quality of life for the individual desolated by hemodialysis sessions, giving back to the patient the possibility of a longer life with better quality, if compared to his/her pre-transplant experience. However, although there is an improvement in quality of life after kidney transplant, the individual experiences changes in the routine, such as incorporate the use of immunosuppressants (8) , frequent visits to the hospital to evaluate health progress and experience a feeling of fear regarding the rejection of the graft (9)(10) .…”

“…Post-transplant complications vary from the most common to the extremely complex, such as infections, urological complications, and graft rejection -all likely to lead to hospitalization and may compromise their quality of life (11) . Studies point to a high risk of depression, anxiety, sleep loss and other psychiatric disorders, with repercussions on quality of life and risk of rejection, indicating the need for psychosocial follow-up before, during and after transplant (3,8,11) .…”

Não adesão medicamentosa nos pacientes transplantados cardíacos

“…In a Brazilian study with kidney transplant patients, general BAASIS scores (10) were used, calculated from the arithmetic sum of the score attributed to questions related to time, dose change, holiday dose and time change; 58.6% of recipients reported total adherence to the immunosuppressive medication, 41.4% did not adhere and 18.8% did not adhere to at least one or more of the four situations assessed (related to time, dose change, holiday dose, and time change) in the previous four weeks (22) .…”

Avaliação Da Adesão Ao Tratamento Imunossupressor Em Pacientes Transplantados Renais Da Cidade De Cruz Alta – Rs

“…12 Empregando-se a escala BAASIS (Basel Assessment of Adherence with immunosuppressive medication Scale), em pacientes de um ambulatório pós-transplante de São Paulo-SP, os resultados isolados dos itens avaliados pela BAASIS® apontaram uma adesão de 94,5%, embora o escore geral mostrou uma não-adesão de 41,4% dos pacientes a uma ou mais das quatro situações avaliadas. 13 Esses trabalhos encontraram uma adesão maior do que os resultados encontrados no presente estudo, ressaltando-se que empregaram questionários diferentes.…”