Abstract
BackgroundNon-adherence (NA) to immunosuppressants (IS) among renal transplant recipients (RTRs) is associated with higher risk of allograft rejection, graft loss, and mortality. A precise measurement of NA is indispensable, although its prevalence differs greatly depending on the respective measurement methods. The objective of this study was to assess the accuracy and concordance of different measurement methods of NA in patients after renal transplantation.Design and methodsThis was a single-center prospective observational study. At baseline (T0), NA was measured via physicians’ estimates (PE), self-reports (SR), and tacrolimus trough level variability (CV%) in 78 RTRs. A Visual Analogue Scale (VAS, 0–100%) was applied both for SR and PE. In addition, we used BAASIS© for SR and a 5-point Likert scale for PE. NA was measured prospectively via electronic monitoring (EM, VAICA©) during a three month period. Meanwhile, all participants received phone calls in a two week interval (T1-T6) during which SRs were given.ResultsSeventy-eight RTRs participated in our study. At t0, NA rates of 6.4%, 28.6%, and 15.4% were found for PE, SR, and CV%, respectively. No correlation was found between these methods. During the study, the percentages of self-reported and electronically monitored adherence remained high, with a minimum mean of 91.2% for the strictest adherence measure (Timing Adherence ±30 min). Our results revealed a moderate to high association between SR and EM. In contrast to PE and CV%, SR significantly predicted electronically monitored adherence. Overall, a decreasing effect of electronically monitored adherence was found for both taking and timing adherence (±2 h, ±30 min) over the course of the study.DiscussionThe moderate to high concordance of SR and EM suggests that both methods measure NA equally accurately. SR seems to be a method that can adequately depict electronically monitored NA and may represent a good and economical instrument to assess NA in clinical practice. The increased adherence at the beginning of the study and its subsequent decrease suggests an intervention effect. Surveillance of IS intake via EM with intermittent phone calls could improve adherence on a short-term basis. To establish long-term effects, further research is necessary.
Highlights
Non-adherence (NA) to immunosuppressants (IS) among renal transplant recipients (RTRs) is associated with higher risk of allograft rejection, graft loss, and mortality
Of 231 eligible RTRs, a total of 184 patients could be contacted by phone. 89 initially agreed to participate in our study. 11 dropped out before activating the pillbox or during the first week, one patient resigned during the first month, and another during the second month of pillbox usage (=NR)
On the Physicians’ Visual Analogue Scale (VAS), adherence ratings ranged from 73% to 100%, with a mean of 92.27% (SD: 5.47). 80.8% of all patients were rated to have an overall adherence of 90% or better
Summary
Non-adherence (NA) to immunosuppressants (IS) among renal transplant recipients (RTRs) is associated with higher risk of allograft rejection, graft loss, and mortality. A precise measurement of NA is indispensable, its prevalence differs greatly depending on the respective measurement methods. A substantial number of renal transplant recipients (RTRs) are non-adherent to their IS medication, on average 35.6% of patients per year [6]. This prevalence differs greatly depending on the respective measurement method, leading to NA rates ranging from 1.6% to 58.7% [7]. For measures of NA in RTRs, self-reports, collateral reports, and IS trough level variability are most frequently applied, due to their inexpensiveness and practicability [8]
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