Nonadherence to immunosuppressives and treatment in kidney transplant: ADHERE BRAZIL Study

Abstract

OBJECTIVE To estimate the prevalence and variability of nonadherence to immunosuppressives and nonpharmacological treatment across kidney transplantation centers and two health access-disparate regions in Brazil. METHODS In a cross-sectional design, a random multistage sample of 1,105 patients was included, based on center transplantation activity (low/moderate/high) and region (R1: North/Northeast/Mid-West; and R2: South/Southeast). Nonadherence to immunosuppressives (implementation phase) was assessed using the Basel Assessment of Adherence to Immunosuppressive Medications Scale (BAASIS)©. Self-report questionnaires assessed nonadherence to physical activity, smoking cessation, alcohol intake, and appointment keeping. We compared regions using the adjusted-χ2 or t-test. RESULTS Most patients were men (58.5%), white (51.4%), and had a mean age of 47.5 (SD = 12.6) years. Regarding kidney transplantation centers, 75.9% were from R2 and 38.2% had low activity. The patients in R2 were older, white-majority, had more frequently steady partners, and received peritoneal dialysis. Nonadherence to immunosuppressives ranged from 11–65.2%; 44.5–90% to physical activity; 0–23.7% to appointment keeping; and 0–14% to smoking cessation. The total prevalence of nonadherence and by region (R1 versus R2) were: for immunosuppressives, 39.7% (44.9% versus 38.1%, p = 0.18); for smoking, 3.9% (1% versus 5%, p < 0.001); for physical activity, 69.1% (71% versus 69%, p = 0.48); for appointment keeping, 13% (12.7% versus 12%, p = 0.77); and for alcohol consumption, 0%. CONCLUSION Despite differences among centers and high variability, only the nonadherence to smoking cessation was higher in the region with greater access to kidney transplantation. We suppose that differences in healthcare access may have been overcome by other positive aspects of the post kidney transplantation treatment.

Changes in Beliefs About Post-Transplant Immunosuppressants Over Time and Its Relation to Medication Adherence and Kidney Graft Dysfunction: A Follow-Up Study

“…The rate in ′taking′ in our study (11.2%) was similar as the findings in the BRIGHT study (17.4%), 27 as well as in the ADHERE BRAZIL study (14.3%). 28 However, issues with ′timing′ were found in 33.8%, 26.5% 27 and 30.6% 28 cases, respectively.…”

“…However, the implementation phase may pose a challenge in the clinical practice, particularly in terms of the exact timing of immunosuppressants. For instance, the BAASIS© was used in a multicentric cross-sectional BRIGHT study with 1397 heart transplant patients and in multicentric cross-sectional ADHERE BRAZIL 28 study with 1105 KTx patients. The rate in ′taking′ in our study (11.2%) was similar as the findings in the BRIGHT study (17.4%), 27 as well as in the ADHERE BRAZIL study (14.3%).…”