Psychosocial Variables Associated with Immunosuppressive Medication Non-Adherence after Renal Transplantation

Abstract

IntroductionNon-adherence to immunosuppressive medication is regarded as an important factor for graft rejection and loss after successful renal transplantation. Yet, results on prevalence and relationship with psychosocial parameters are heterogeneous. The main aim of this study was to investigate the association of immunosuppressive medication non-adherence and psychosocial factors.MethodsIn 330 adult renal transplant recipients (≥12 months posttransplantation), health-related quality of life, depression, anxiety, social support, and subjective medication experiences were assessed, and their associations with patient-reported non-adherence was evaluated.Results33.6% of the patients admitted to be partially non-adherent. Non-adherence was associated with younger age, poorer social support, lower mental, but higher physical health-related quality of life. There was no association with depression and anxiety. However, high proportions of clinically relevant depression and anxiety symptoms were apparent in both adherent and non-adherent patients.ConclusionIn the posttransplant follow-up, kidney recipients with lower perceived social support, lower mental and higher physical health-related quality of life, and younger age can be regarded as a risk group for immunosuppressive medication non-adherence. In follow-up contacts with kidney transplant patients, physicians may pay attention to these factors. Furthermore, psychosocial interventions to optimize immunosuppressive medication adherence can be designed on the basis of this information, especially including subjectively perceived physical health-related quality of life and fostering social support seems to be of importance.

<p>Optimization of Electronically Monitored Non-Adherence in Highly Adherent Renal Transplant Recipients by Reducing the Dosing Frequency – A Prospective Single-Center Observational Study</p>

“…A possible reason could also be the low prevalence of depression in our cohort (11.69%), compared to other study populations depicting prevalence rates between 13.2% and 60%. 15,18,28,71 At the same time, protective factors such as self-efficacy, social support, and quality of life, as well as satisfaction with information were average to high and comparable to an average healthy population.…”

“…12 In this context, factors such as negative beliefs and attitudes towards medication or treatment, [13][14][15][16] as well as adherence barriers 14,16,17 were previously examined and found to be significantly associated with adherence behavior. However, various other patient-related factors have been linked to medication NA in renal transplant recipients as well, such as depression, 13,15,[18][19][20] anxiety, 13,18 sex, [21][22][23] education, 20,21 marital status, 13,24 lower self-efficacy, 22,25,26 avoidant attachment, 27 lower social support, 18,21,28,29 lower quality of life, 14,28 non-white ethnicity, 4,20 higher frequency of medication intake, [30][31][32][33][34] type of renal graft, 20,35 longer time since transplantation, 20,23,36 and younger age. 2,4,…”

“…However, various other patient-related factors have been linked to medication NA in renal transplant recipients as well, such as depression, 13,15,[18][19][20] anxiety, 13,18 sex, [21][22][23] education, 20,21 marital status, 13,24 lower self-efficacy, 22,25,26 avoidant attachment, 27 lower social support, 18,21,28,29 lower quality of life, 14,28 non-white ethnicity, 4,20 higher frequency of medication intake, [30][31][32][33][34] type of renal graft, 20,35 longer time since transplantation, 20,23,36 and younger age. 2,4,20,24,28,36 Still, there are many contradictory findings in the current research, due to different measurement methods of NA. 28 A bandwidth of direct and indirect measurement methods for NA has emerged lately: Direct measures include direct observation, measurement of immunosuppressive (IS) levels or biomarkers in the blood, whilst indirect measures comprise pill counts, self-reports, physicians' reports, pharmacy records, or electronic monitoring (EM).…”

“…[41][42][43][44][45] Although highly debated, some research considers EM the best measure of adherence currently available. 4,11,46 To our knowledge, most studies rely on self-reports, physician's estimates, or IS levels in the blood when examining possible determinants for NA, 13,15,17,18,21,23,[25][26][27][28]36 whilst only a few have examined this association by applying EM. 22,24,30,31,35 Therefore, the aim of this study was to investigate the associations between electronically monitored adherence and patient-related factors in order to unravel the etiology of adherence as well as to optimize future adherence interventions.…”

Kidney Transplantation and “Sex Mismatch”: A 10-Year Single-Center Analysis

“…The compliance of the patient after a KT and the adherence to immunosuppression therapy influence the occurrence of rejection and survival of the graft after a KT [ 12 ]. The influence and significance of these factors also depends on the sex and age of the recipient [ 13 , 14 ]. So far there was only one analysis that dealt with the current impact of the different sex and age category of donors and recipients on graft survival after a KT [ 11 ]; the majority of the published studies assessed the relationship between these factors and the graft survival in isolation.…”