Abstract
Kidney transplantation (KT) is the best method for kidney replacement therapy (KRT) because of patient survival rates and quality of life (QoL). Nowadays, the main cause of graft loss is antibody-mediated rejection. The treatment of humoral injury is difficult with uncertain results and still not firmly established. Therefore, appropriate adherence is crucial to prolong graft and patient survival. This study aims to evaluate the association of transplant patients’ acceptance of illness, symptoms of anxiety and depression, frailty, and QoL with medication adherence in KT recipients. A total of 210 patients after KT completed the surveys. The instruments were distributed during patients’ admission at the clinic by a qualified nurse, who assisted the patients’ in completing the questionnaires. A cross-sectional study of KT recipients 9.45 ± 7.26 years after KT was performed. Patient adherence with medications was assessed using the Adherence to Refills and Medications Scale (ARMS). Explanatory variables were examined with validated instruments, such as the World Health Organization Quality of Life (WHOQoL-BREF) questionnaire, The Mini-Mental State Examination (MMSE), the Acceptance of Illness Scale (AIS), the Hospital Anxiety and Depression Scale (HADS), and the Tilburg Frailty Indicator (TFI) scale, respectively. Simple linear and multiple regression analyses demonstrated the positive correlation between acceptance of illness and adherence to immunosuppressive medications in a patient sample of KT recipients. The other important factor facilitating adherence to medications was linked with physical and environmental dimensions. On the other hand, frail kidney transplant patients were more likely to be non-adherent. In conclusion, identifying contributors to better medication adherence in immunosuppressive therapy is crucial in preventing transplant rejection or graft loss. In the kidney transplant population, the acceptance of illness, selected dimensions of QoL, and demographic variables associated with rural living and vocational education favored adherence behaviors.
Highlights
We found that rural living was associated with decreasing the ARMS score by 0.733 points on average, B = −0.733, 95% confidence intervals (CI): [−1.388, −0.079]; p = 0.029
Our findings show that ARMS identifies the barriers to adherence in Kidney transplantation (KT) patients well, which might be useful in research study and clinical practice in kidney transplantation
The acceptance of illness is associated with an adherence to immunosuppressive medications in a patient sample of KT recipients
Summary
Non-adherence is a major risk factor for rejection and allograft loss among transplant recipients [1–3]. Medical reports on non-adherence to immunosuppressive therapies after a transplant state that non-adherence is more prevalent than previously assumed. A variety of reasons for non-adherence occurrence may cause difficulty in its relevant recognition and assessment. Even though non-adherence in a population of transplant recipients is costly on several levels (for instance, social, medical, and economic), it is resistant to change from a behavioral perspective [4]
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