Patient-reported non-adherence and immunosuppressant trough levels are associated with rejection after renal transplantation

Scheel, Jennifer; Reber, Sandra; Stoessel, Lisa; Waldmann, Elisabeth; Jank, Sabine; Eckardt, Kai‐Uwe; Grundmann, Franziska; Vitinius, Frank; Zwaan, Martina de; Bertram, Anna; Erim, Yeşim

doi:10.1186/s12882-017-0517-6

Cited by 57 publications

(68 citation statements)

References 36 publications

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“…Overall the present study showed that nonadherence was because of suboptimal implementation of the IS medications the first post‐transplant year. Self‐reported nonadherence using BAASIS © in this population was 29% at 1‐year, which is in line with previous studies . As other reports also have shown , the majority of these NoAd patients took all the prescribed doses but had a time deviation (22%).…”

Section: Discussionmentioning

confidence: 99%

Evaluation of tools for annual capture of adherence to immunosuppressive medications after renal transplantation - a single-centre open prospective trial

et al. 2019

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Summary Annual assessment of adherence would strengthen long‐term outcome assessments from registry data. The objective of this study was to evaluate tools suitable for annual routine capture of adherence data in renal transplant recipients. A single‐centre open prospective trial included 295 renal transplant recipients on tacrolimus. Two‐thirds of the patients were included 4 weeks post‐transplant, randomized 1:1 to intensive or single‐point adherence assessment in the early phase and 1‐year post‐transplant. One‐third were included 1‐year post‐transplant during a cross‐sectional investigation. Adherence was assessed using multiple methods: The “Basel Assessment of Adherence to Immunosuppressive Medication Scale” (BAASIS©) questionnaire was used to assess self‐reported adherence. The treating clinician scored patient′s adherence and tacrolimus trough‐concentration variability was calculated. In the analyses, the data from the different tools were dichotomized (adherent/nonadherent). The BAASIS© overall response rate was over 80%. Intensive BAASIS© assessment early after transplantation increased the chance of capturing a nonadherence event, but did not influence the 1‐year adherence prevalence. The adherence tools generally captured different populations. Combining the tools, the nonadherence prevalence at 1 year was 38%. The different tools identified to a large degree different patients as nonadherent. Combining these tools is feasible for annual capture of adherence status.

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Section: Discussionmentioning

confidence: 99%

Evaluation of tools for annual capture of adherence to immunosuppressive medications after renal transplantation - a single-centre open prospective trial

et al. 2019

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“…Reinforced action by a systematic review of self-reported instruments to identify noncompliance with medication, where BAASIS® was recommended as a reliable, valid and sensitive tool. (21) Measurement of adherence has implications for nursing and interdisciplinary practice, and it is relevant because of the high investment of the public health system-more than 50% of the annual transplantation budget is directed to immunosuppressant drugs. (22) Therefore, the evaluation of adherence in recipients who have undergone transplantation must be considered to support actions for the therapeutic plan after KTP and in this way will help reduce investment in treatment of complications due to nonadherence.…”

Section: Discussionmentioning

confidence: 99%

Mensuração da adesão aos medicamentos imunossupressores em receptores de transplante renal

et al. 2018

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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...

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“…Die Non-Adhärenz-Schwelle wird also sehr niedrig angelegt. Dennoch muss bei einer Selbsteinschätzung immer von einer Erinnerungsverzerrung ("recall bias") ausgegangen werden, sowie dem Wunsch des Patienten, sozial erwünschtes Verhalten zu zeigen [19]. Dies kann zur Folge haben, dass non-adhärente Verhaltensweisen nicht berichtet werden und es dadurch zu einer Unterschätzung der Non-Adhärenz kommt [14,19,20].…”

Section: Selbsteinschätzungunclassified

“…Allerdings ist nicht jede Spiegelveränderung auf Unregelmäßigkeiten in der Medikamenteneinnahme zurückzuführen. Auch durch pharmakokinetische Phänomene und Interaktionen zwischen verschiedenen Medikamenten können Veränderungen des Immunsuppressiva-Spiegels hervorgerufen werden [19,22]. Schäfer-Keller et al [20] kommen zu dem Schluss, dass eine Adhärenzbestimmung auf Grundlage der Spiegel zu einer Überschätzung der Non-Adhärenz führt.…”

Section: Bestimmung Der Medikamentenspiegelunclassified

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Immunsuppressiva-Adhärenz nach Transplantation

Nöhre

Erim

Vitinius

et al. 2018

Psychother Psych Med

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Organ transplantation is the best and to some extent only option for many patients with chronic organ failure. Usually after successful transplantation patients experience a significant improvement of their condition. Nevertheless, they are not cured but still chronically ill. Living with an organ transplant requires consequent immunosuppression intake, regular physician visits and following the recommendations regarding infection prevention. These factors are important to secure a long transplant survival. Especially non-adherence to immunosuppressants is known as a risk factor for transplant rejection. There are several reasons for non-adherent behavior. However identifying the individual motivations is crucial for addressing them correctly. The aim of this article is to give an overview of factors influencing adherence, to introduce options to assess adherence and to present ways to improve adherence. Randomized-controlled intervention studies are presented and on that basis recommendations for clinical practice are derived.

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Patient-reported non-adherence and immunosuppressant trough levels are associated with rejection after renal transplantation

Cited by 57 publications

References 36 publications

Evaluation of tools for annual capture of adherence to immunosuppressive medications after renal transplantation - a single-centre open prospective trial

Evaluation of tools for annual capture of adherence to immunosuppressive medications after renal transplantation - a single-centre open prospective trial

Mensuração da adesão aos medicamentos imunossupressores em receptores de transplante renal

Immunsuppressiva-Adhärenz nach Transplantation

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