Prevalence of Non-Adherence to Immunosuppressive Medications in Kidney Transplant Recipients: Barriers and Predictors

Abstract

Background Non-adherence to immunosuppressant therapy (IST) is a major risk factor for graft rejection. Limited reports are available regarding the prevalence of non-adherence to IST in kidney transplant recipients (KTRs) as well as the predictors and barriers of non-adherence. Material/Methods The study included ambulatory KTRs, ≥18 years of age, with a functional kidney, from January 2017 to November 2018. The primary outcome was the prevalence of non-adherence, assessed with: 1) A telephone interview to complete the Arabic-translated and validated Immunosuppressant Therapy Adherence Instrument Scale (ITAS) and 2) IST serum blood levels within therapeutic levels. The secondary outcomes were the barriers to adherence using the validated Immunosuppressant Therapy Barriers of Adherence Scale (ITBS). Results We enrolled 102 of 141 patients screened. The mean±SD for age, body mass index, and the baseline of the estimated glomerular filtration rate were 45.5±15.6 years, 29.1±6 kg/m 2 , and 72.7±21.9 ml/min/1.73 m 2 , respectively. The prevalence of non-adherence was 5.9%, 95% CI (2.19–12.36%) and 14.7%, 95% CI (8.47–23.09%) using the ITAS and the average blood serum drug levels, respectively. The concordance of the 2 methods demonstrated an agreement of 81.3%, kappa of 0.01, and 95% CI (−0.16 to 0.18). The median, interquartile range (IQR) for ITBS, and uncontrollable and controllable barriers for adherence were 21, (18–25), 15, (12–18), and 6, (5–8), respectively. Conclusions The current study demonstrated a low to moderate prevalence of non-adherence to IST in KTRs. The barriers for adherence with IST necessitate additional targeted interventions to manage and optimize therapeutic and clinical outcomes.

Evaluation of the use of a Renal Health application by kidney transplant recipients

“…However, low HL is frequent among transplant candidates and recipients 12 . Non-adherence to treatment, especially to medication, is also considered high in KT 13 - 14 , and the reasons for this are complex and multifactorial, and therefore represent a challenge for the entire healthcare team 15 .…”

“…However, low HL is frequent among transplant candidates and recipients (12) . Non-adherence to treatment, especially to medication, is also considered high in KT (13)(14) , and the reasons for this are complex and multifactorial, and therefore represent a challenge for the entire healthcare team (15) . Some eHealth tools have been developed and tested as a strategy to expand HL, improve self-monitoring, and reduce non-adherence in KT (8,(16)(17)(18)(19) .…”

Avaliação do uso do aplicativo Renal Health por transplantados renais

“…Entretanto, o baixo LS é frequente entre candidatos ao transplante e transplantados (12) . A não adesão ao tratamento, especialmente ao medicamentoso, também é considerada elevada no TR (13)(14) , e suas causas têm caráter complexo, multifatorial e, portanto, representam um desafio para toda a equipe de saúde (15) .…”

Evaluación del uso de la Aplicación Renal Health por parte de los receptores de trasplante renal

“…Sin embargo, la AS baja es frecuente entre los candidatos al trasplante y los trasplantados (12) . La no adherencia al tratamiento, especialmente a la medicación, también es considerada alta en TR (13)(14) , sus causas son complejas y multifactoriales, por lo tanto, representan un desafío para todo el equipo de salud (15) . Como estrategia para ampliar la AS, ayudar en la auto monitorización y reducir la no adherencia en TR, se han desarrollado y probado algunas herramientas eHealth (8,(16)(17)(18)(19) .…”