Evaluation of adherence to immunosuppressive therapy by self-report of patients submitted to renal transplantation
DOI:
https://doi.org/10.15448/1980-6108.2017.4.28181Keywords:
medication adherence, patient compliance, kidney transplantation.Abstract
AIMS: To evaluate the characteristics and risk factors related to the adherence to immunosuppressive treatment of renal transplant patients using the self-report method by means of the Basel Assessment of Adherence Scale for Immunosuppressives (BAASIS).
METHODS: A prospective cohort study with a quantitative approach was performed at the Nephrology and Transplantation Service of São Lucas Hospital of the Pontifical Catholic University of Rio Grande do Sul, with patients older than 18 years, transplanted from kidneys from deceased or living donors, with a minimum transplant time of three months and a maximum of 12 months. The BAASIS instrument was applied to evaluate adhesion. For statistical analysis, Fisher exact test (Monte Carlo simulation) was used to verify the association between the categorical variables, Student t test for independent sample means and Mann Whitney test in the variables without normality. A p<0.05 was adopted for the results to be considered significant.
RESULTS: The sample consisted of 59 patients, 57.6% of whom were male, 79.7% were white, the mean age was 45.8 years, 57.6% had elementary school and 72.9% were catholic. Hemodialysis was the most used method, in 86.4% of patients before transplantation, and the mean time in the waiting list was 19.5 months. After transplantation, the mean time of hospitalization was 17.2 days. The assessment of adherence by BAASIS characterized 83% of patients as non-adherent. The main fact considered as non-adherence was to take the immunosuppressive drugs with more than two hours difference from the prescribed time, at least once a week, in the last four weeks. There was no significant difference when the statistical analysis was performed to compare the adhesion rate among the various categories of the demographic and clinical variables of the patients.
CONCLUSIONS: A high rate of patients not adherent to the immunosuppressive treatment was identified, and the change in the schedule of immunosuppressants was the main fact that characterized this behavior. A shorter waiting time in the transplant queue was associated with non-adherence. The other variables, demographic and clinical, were not associated to the classification of adherent or non-adherent.
Downloads
References
Tonelli M, Wiebe N, Knoll G, Bello A. Systematic Review : Kidney Transplantation Compared With Dialysis in Clinically Relevant Outcomes. Am J Transplant. 2011;11:2093-109. https://doi.org/10.1111/j.1600-6143.2011.03686.x
Ball S, Dallman MJ. Immunology of Graft Rejection. In: Sciences EH, editor. Kidney Transplantation - Principles and Practice. 7th ed. 2013. p. 880.
Landreneau K, Lee K, Landreneau M. Quality of life in patients undergoing hemodialysis and renal transplantation: a meta-analytic review. Nephrol Nurs J. 2010;37(1):37-44.
Garcia CD, Pereira JD, Zago MK, Garcia VD. Manual de Doação e Transplantes. 1a. Rio de Janeiro: Elsevier Editora Ltda; 2013. 352 p.
Mercado-Martinez FJ, Ibarra-Hernández E, Asencio-Mera CD, Diaz-Medina B a., Padilla-Altamira C, Kierans C. Viviendo con Trasplante Renal, Sin Protección Social en Salud. ¿Qué Dicen los Enfermos sobre las Dificultades Económicas que Enfrentan y sus Efectos? Cad Saude Publica. 2014;30(10):2092-100. https://doi.org/10.1590/0102-311X00150713
Robinson BM, Akizawa T, Jager KJ, Kerr PG, Saran R, Pisoni RL. Factors affecting outcomes in patients reaching end-stage kidney disease worldwide: differences in access to renal replacement therapy, modality use, and haemodialysis practices. Lancet. 2016;388(10041):294-306. https://doi.org/10.1016/S0140-6736(16)30448-2
Sociedade Brasileira de Nefrologia. Censo da Sociedade Brasileira de Nefrologia 2016 [Internet] São Paulo; 2017 [cited 2017 jun 10]. Available from: http://censo-sbn.org.br/censosAnteriores
Associação Brasileira de Transplante de Órgãos - ABTO. Registro Brasileiro de Transplantes 2016 [Internet]. São Paulo; 2017 [cited 2017, jun 8]. Available from: http://www.abto.org.br/abtov03/Upload/file/RBT/2016/RBT2016-leitura.pdf
Associação Brasileira de Transplante de Órgãos - ABTO. Registro Brasileiro de Transplantes, Janeiro/Marco-2017 [Internet]. São Paulo; 2017 [cited 2017, jun 8]. Available from: http://www.abto.org.br/abtov03/Upload/file/RBT/2017/2017_leitura_1T.pdf
Denhaerynck K, Steiger J, Bock A, Schäfer-Keller P, Köfer S, Thannberger N, De Geest S. Prevalence and risk factors of non-adherence with immunosuppressive medication in kidney transplant patients. Am J Transplant. 2007;7(1):108-16. https://doi.org/10.1111/j.1600-6143.2006.01611.x
Prendergast MB, Gaston RS. Optimizing medication adherence: An ongoing opportunity to improve outcomes after kidney transplantation. Clin J Am Soc Nephrol. 2010;5(7):1305-11. https://doi.org/10.2215/CJN.07241009
Gordon EJ, Gallant M, Sehgal AR, Conti D, Siminoff LA. Medication-taking among adult renal transplant recipients. Transpl Int. 2009;22(5):534-45. https://doi.org/10.1111/j.1432-2277.2008.00827.x
Fine RN, Becker Y, De Geest S, Eisen H, Ettenger R, Evans R, Rudow DL, McKay D, Neu A, Nevins T, Reyes J, Wray J, Dobbels F. Nonadherence consensus conference summary report. Am J Transplant. 2009;9(1):35-41. https://doi.org/10.1111/j.1600-6143.2008.02495.x
Schafer-Keller P, Steiger J, Bock A, Denhaerynck K, De Geest S. Diagnostic Accuracy of Measurement Methods to Assess Non-Adherence to Immunosuppressive Drugs in Kidney Transplant Recipients. Am J Transplant. 2008;8:616-26. https://doi.org/10.1111/j.1600-6143.2007.02127.x
Osterberg L, Blaschke T. Adherence to medication. Nejm. 2005;353:487-97. https://doi.org/10.1056/NEJMra050100
Chisholm MA, Lance CE, Williamson GM, Mulloy LL. Development and validation of the immunosuppressant therapy adherece instrument (ITAS). Patient Educ Couseling. 2005;59:13-20. https://doi.org/10.1016/j.pec.2004.09.003
Marsicano Ede O, Fernandes Nda S, Colugnati F, Grincenkov FR, Fernandes NM, De Geest S, Sanders-Pinheiro H. Transcultural adaptation and initial validation of Brazilian-Portuguese version of the Basel assessment of adherence to immunosuppressive medications scale (BAASIS) in kidney transplants. BMC Nephrol. 2013;14:108. https://doi.org/10.1186/1471-2369-14-108
Dobbels F, Berben L, De Geest S, Drent G, Lennerling A, Whittaker C, Kugler C; Transplant360 Task Force. The psychometric properties and practicability of self-report instruments to identify medication nonadherence in adult transplant patients: a systematic review. Transplantation. 2010;90(2):205-19. https://doi.org/10.1097/TP.0b013e3181e346cd
Lennerling A, Forsberg A. Self-reported non-adherence and beliefs about medication in a Swedish kidney transplant population. Open Nurs J. 2012;6:41-6. https://doi.org/10.2174/1874434601206010041
Dew MA, DiMartini AF, De Vito Dabbs A, Myaskovsky L, Steel J, Unruh M, Switzer GE, Zomak R, Kormos RL, Greenhouse JB. Rates and Risk Factors for Nonadherence to the Medical Regimen After Adult Solid Organ Transplantation. Transplantation. 2007;83(7):858-73. https://doi.org/10.1097/01.tp.0000258599.65257.a6
De Geest S, Burkhalter H, Bogert L, Berben L, Glass TR, Denhaerynck K. Describing the evolution of medication nonadherence from pretransplant until 3 years post-transplant and determining pretransplant medication nonadherence as risk factor for post-transplant nonadherence to immunosuppressives: The Swiss Transplant Cohort S. Transpl Int. 2014;27(7):657-66. https://doi.org/10.1111/tri.12312
Massey EK, Tielen M, Laging M, Timman R, Beck DK, Khemai R, van Gelder T, Weimar W. Discrepancies between beliefs and behavior: a prospective study into immunosuppressive medication adherence after kidney transplantation. Transplantation. 2015;99(2):375-80. https://doi.org/10.1097/TP.0000000000000608
Massey EK, Tielen M, Laging M, Beck DK, Khemai R, van Gelder T, Weimar W. The role of goal cognitions, illness perceptions and treatment beliefs in self-report adherence after kidney transplantation: A cohort study. J Psychosom Res. 2013;229-34. https://doi.org/10.1016/j.jpsychores.2013.07.006
Couzi L, Moulin B, Morin M-P, Albano L, Godin M, Barrou B, Alamartine E, Morelon E, Girardot-Seguin S, Mendes L, Misdrahi D, Cassuto E, Merville P. Factors Predictive of Medication Nonadherence After Renal Transplantation: A French Observational Study. Transplant J. 2013;95(2):326-32. https://doi.org/10.1097/TP.0b013e318271d7c1
Massey EK, Meys K, Kemer R, Weimar W, Roodnat J, Cransberg K. Young Adult Kidney Transplant Recipients: Nonadherent and Happy. Transplantation. 2015;99(8):89-96. https://doi.org/10.1097/TP.0000000000000639
Spivey CA, Chisholm-Burns MA, Damadzadeh B, Billheimer D. Determining the effect ofimmunosuppressant adherence on graftfailure risk among renal transplant recipients. Clin Transplant. 2014;28:96-104. https://doi.org/10.1111/ctr.12283
Burkhalter H, Wirz-Justice A, Cajochen C, Weaver TE, Steiger J, Fehr T, Venzin RM, De Geest S. Daytime sleepiness in renal transplantrecipients is associated with immunosuppressive non-adherence: across-sectional, multi-center study. Clin Transplant. 2014;28:58-66. https://doi.org/10.1111/ctr.12279
Akman B, Uyar M, Afsar B, Sezer S, Ozdemir FN, Haberal M. Adherence, depression and quality of life in patients on a renal transplantation waiting list. Transpl Int. 2007;20(8):682-7. https://doi.org/10.1111/j.1432-2277.2007.00495.x
Silva AN, Moratelli L, Tavares PL, Marsicano E de O, Pinhati RR, Colugnati FA, Lucchetti G, Sanders-Pinheiro H. Self-efficacy beliefs, locus of control, religiosity and non-adherence to immunosuppressive medications in kidney transplant patients. Neprology. 2016;21(11):938-43. https://doi.org/10.1111/nep.12695
Tielen M, van Exel J, Laging M, Beck DK, Khemai R, van Gelder T, Betjes MG, Weimar W, Massey EK. Attitudes to medication after kidney transplantation and their association with medication adherence and graft survival: a 2-year follow-up study. J Transpl. 2014;2014:675301. https://doi.org/10.1155/2014/675301
Downloads
Published
How to Cite
Issue
Section
License
Copyright
The submission of originals to Scientia Medica implies the transfer by the authors of the right for publication. Authors retain copyright and grant the journal right of first publication. If the authors wish to include the same data into another publication, they must cite Scientia Medica as the site of original publication.
Creative Commons License
Except where otherwise specified, material published in this journal is licensed under a Creative Commons Attribution 4.0 International license, which allows unrestricted use, distribution and reproduction in any medium, provided the original publication is correctly cited.
