Prevalence and correlates of medication non-adherence among kidney transplant recipients more than 6 months post-transplant: a cross-sectional study

Abstract

BackgroundAmong kidney transplant recipients, non-adherence with immunosuppressive medications frequently precedes allograft loss. We sought to determine the prevalence and correlates of medication non-adherence among kidney transplant recipients.MethodsWe performed a single-center, cross-sectional study of kidney transplant recipients who were at least 6 months post-transplant. We measured self-reported adherence using the Immunosuppressive Therapy Adherence Scale (ITAS, which is scored from 0 to 12, where higher scores indicate increased adherence) and barriers to adherence using the Immunosuppressive Therapy Barriers Scale (ITBS). We also used validated scales to measure perceived stress, health literacy, anxiety, depression, and interpersonal support.ResultsThe 252 patients included in the study were 59.9% male, 27.0% Black, and at a median of 2.9 years post-transplant (interquartile range [IQR] 1.4-5.8). On the ITAS, 59.1% scored a perfect 12, 26.6% scored 10–11, and 14.3% scored 0–9. In univariate models, non-adherence (defined as ITAS score ≤9) was significantly associated with increased scores on scales for perceived stress (OR 1.12, 95% CI 1.01-1.25) and depression (OR 1.14, 95% CI 1.02-1.28), and with more self-reported barriers to adherence on the ITBS (OR 1.15, 95% CI 1.08-1.22). After adjusting for sociodemographic factors, stress and depression were not associated with non-adherence. Higher scores on the ITBS (corresponding to more self-described barriers to adherence) were associated with lower scores on the ITAS (P < 0.001). Several individual barriers were associated with non-adherence.ConclusionsAmong prevalent kidney transplant recipients, a minority is non-adherent. Practical barriers to adherence may serve as promising targets for future interventions.

Prevalence and Modifiable Determinants of Non-Adherence in Adult Kidney Transplant Recipients in a German Sample

“…Several elements of behavior have been focused on including: Health beliefs (Butler et al 2004); norms, attitudes, and barriers (Schmid-Mohler et al 2010); beliefs about medicines, and barriers (Chisholm-Burns et al 2012); medication beliefs, quality of life, depression, and transplantation-specific emotions (Griva et al 2012); as well as barriers, depressive affects, and perceived stress (Weng et al 2013). The effects of emotion and mood have also been surveyed and are likely to be important.…”

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“…22 We can also speculate that providing immunosuppressive therapy free of cost helps to limit the graft loss that can result from poor medication adherence related to limited financial resources. 23 Unfortunately, some of our patients have lost their kidney grafts after an abrupt withdrawal of immunosuppressive therapy. Graft loss was observed mainly in young recipients who were faced with psychosocial conflicts.…”

“…Graft loss was observed mainly in young recipients who were faced with psychosocial conflicts. 23,24 The long follow-up duration and successive changes in our immuno suppressive regimens did not allow us to determine the effects of both induction and maintenance immunosuppressive therapy on graft and patient survival rates and the occurrence of posttransplant complications. Because of restrictive government policy, we have used generic formulations of mycophenolate mofetil and tacrolimus exclusively during the past years; both are locally manufactured.…”

Manualisierte Psychotherapie zur Optimierung der Immunsuppressiva-Adhärenz bei Patienten nach Nierentransplantation: Ergebnisse einer Machbarkeitsstudie

“…Bei Nierentransplantationspatienten konnte ein bedeutsamer Einfluss von Gesundheitsüberzeugungen nach dem Health-Belief-Modell auf die Adhärenz nachgewiesen werden (Chisholm-Burns et al 2012;Griva et al 2012;Massey et al 2013;Weng et al 2013). Das Health-Belief-Modell dient der Analyse und Vorhersage von gesundheitsbezogenem Verhalten und bietet eine mögliche Erklärung für Non-Adhärenz bei nierentransplantierten Patienten.…”