Preferential Adherence to Immunosuppressive Over Nonimmunosuppressive Medications in Kidney Transplant Recipients

Terebelo, Sima; Markell, Mariana S.

doi:10.1016/j.transproceed.2010.08.027

Cited by 22 publications

(19 citation statements)

References 27 publications

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“…This effect may be due in part to the perceived importance of medications with progressive comorbidity. This has been reported in transplant recipients, in which preferential adherence is associated with immunosuppressant treatment (20). Chiu et al (21) reported a positive association of phosphate binder pill burden and nonadherence in a chronic dialysis population.…”

Section: Discussionmentioning

confidence: 73%

Medication Treatment Complexity and Adherence in Children with CKD

Blydt-Hansen

Pierce

Cai

et al. 2014

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives The complexity of CKD management in children is increased by the number of comorbid conditions. This study assessed the prevalence of comorbidities in pediatric CKD and the frequency with which multiple comorbidities present together by assessing prevalent medication use by CKD stage and diagnosis and their association with clinical or sociodemographic factors. The association between number and frequency of dosing of medications prescribed and self-report of nonadherence was also assessed.Design, setting, participants, & measurements In this cross-sectional analysis of the Chronic Kidney Disease in Children study, medication use at study entry grouped by indication was examined by CKD stage, diagnosis, age, race, ethnicity, income, and CKD duration. Multivariate adjusted predictors of medication use and clustering were examined. Nonadherence was assessed by self-report of missed medications in the past 7 days.Results The 558 eligible participants had a median age of 11 years and median GFR of 44 ml/min per 1.73 m 2 ; 62% of participants were male and 78% had nonglomerular kidney disease. The number of medications for treatment of CKD comorbidities increased with advanced CKD stage (2.5-fold for stages IV versus II; P,0.001) and glomerular disease (1.4-fold versus nonglomerular; P,0.001). Three distinct medication clusters were identified that corresponded to treatment of glomerular disease, advanced renal tubular dysfunction, and proteinuric complications, respectively. Nonadherence was associated with increased medication dosing frequency (administration .2 times/d; P,0.001) but not the number of medications.Conclusions Medical therapy for children with CKD is complex and is affected by glomerular diagnosis, CKD stage, and medication frequency. The need for CKD-related medication treatment cannot be easily predicted by CKD staging alone. Poorer adherence was associated with increased medication frequency, but not with the number of medical problems needing treatment. Consolidating medical treatment and reducing medication frequency may improve adherence rates in children with CKD.

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Section: Discussionmentioning

confidence: 73%

Medication Treatment Complexity and Adherence in Children with CKD

Blydt-Hansen

Pierce

Cai

et al. 2014

Clinical Journal of the American Society of Nephrology

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“…Renal transplant recipients may also have preferential adherence to their immunosuppressant therapy over nonimmunosuppressant therapy including antihypertensive medications. This was shown by Terebelo et al, who demonstrated adherence rates of 81.6% to immunosuppressant therapy versus 55.1% to nonimmunosuppressant therapy among renal transplant recipients in New York, USA ( p = 0.028) [9]. Other predictors of uncontrolled hypertension among renal transplant recipients include older recipient and donor age, male sex, higher levels of proteinuria, and low GFR, as well as cyclosporine and steroid use [10–13].…”

Section: Introductionmentioning

confidence: 98%

Factors Associated with Uncontrolled Hypertension among Renal Transplant Recipients Attending Nephrology Clinics in Nairobi, Kenya

KUBO

Kayima

Were

et al. 2015

Journal of Transplantation

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Objective. To determine the factors associated with poor blood pressure control among renal transplant recipients in a resource-limited setting. Methods. A cross-sectional study was carried out on renal transplant recipients at the Kenyatta National Hospital. Sociodemographic details, blood pressure, urine albumin : creatinine ratio, and adherence using the MMAS-8 questionnaire were noted. Independent factors associated with uncontrolled hypertension were determined using logistic regression analysis. Results. 85 subjects were evaluated. Mean age was 42.4 (SD ± 12.2) years, with a male : female ratio of 1.9 : 1. Fifty-five patients (64.7%) had uncontrolled hypertension (BP ≥ 130/80 mmHg). On univariate analysis, male sex (OR 3.7, 95% CI 1.4–9.5, p = 0.006), higher levels of proteinuria (p = 0.042), and nonadherence to antihypertensives (OR 18, 95% CI 5.2–65.7, p < 0.001) were associated with uncontrolled hypertension. On logistic regression analysis, male sex (adjusted OR 4.6, 95% CI 1.1–19.0, p = 0.034) and nonadherence (adjusted OR 33.8, 95% CI 8.6–73.0, p < 0.001) were independently associated with uncontrolled hypertension. Conclusion. Factors associated with poor blood pressure control in this cohort were male sex and nonadherence to antihypertensives. Emphasis on adherence to antihypertensive therapy must be pursued within this population.

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“…Malnutrition is prevalent in the dialysis population, and the lack of reimbursement for nutritional support can be a barrier to patients as the criteria for qualification can be strict [22]. Optimizing patient education may also be the key to improving outcomes, given the occurrence of non-adherence to treatment plans and the burden of polypharmacy [23,24]. Continuous patient-specific education on the benefits of treatment and the consequences of non-adherence, communicated in understandable and culturally sensitive terms may help to motivate patients and ensure their active and effective participation.…”

Section: Discussionmentioning

confidence: 99%

Mortality after Renal Allograft Failure and Return to Dialysis

Brar

Markell²,

Stefanov³

et al. 2017

Am J Nephrol

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Introduction: The outcomes of patients who fail their kidney transplant and return to dialysis (RTD) has not been investigated in a nationally representative sample. We hypothesized that variations in management of transplant chronic kidney disease stage 5 leading to kidney allograft failure (KAF) and RTD, such as access, nutrition, timing of dialysis, and anemia management predict long-term survival. Methods: We used an incident cohort of patients from the United States Renal Data System who initiated hemodialysis between January 1, 2003 and December 31, 2008, after KAF. We used Cox regression analysis for statistical associations, with mortality as the primary outcome. Results: We identified 5,077 RTD patients and followed them for a mean of 30.9 ± 22.6 months. Adjusting for all possible confounders at the time of RTD, the adjusted hazards ratio (AHR) for death was increased with lack of arteriovenous fistula at initiation of dialysis (AHR 1.22, 95% CI 1.02-1.46, p = 0.03), albumin <3.5 g/dL (AHR 1.33, 95% CI 1.18-1.49, p = 0.0001), and being underweight (AHR 1.30, 95% CI 1.07-1.58, p = 0.006). Hemoglobin <10 g/dL (AHR 0.96, 95% CI 0.86-1.06, p = 0.46), type of insurance, and zip code-based median household income were not associated with higher mortality. Glomerular filtration rate <10 mL/min/1.73 m² at time of dialysis initiation (AHR 0.83, 95% CI 0.75-0.93, p = 0.001) was associated with reduction in mortality. Conclusions: Excess mortality risk observed in patients starting dialysis after KAF is multifactorial, including nutritional issues and vascular access. Adequate preparation of patients with failing kidney transplants prior to resuming dialysis may improve outcomes.

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Preferential Adherence to Immunosuppressive Over Nonimmunosuppressive Medications in Kidney Transplant Recipients

Cited by 22 publications

References 27 publications

Medication Treatment Complexity and Adherence in Children with CKD

Medication Treatment Complexity and Adherence in Children with CKD

Factors Associated with Uncontrolled Hypertension among Renal Transplant Recipients Attending Nephrology Clinics in Nairobi, Kenya

Mortality after Renal Allograft Failure and Return to Dialysis

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