Adherence to Pharmacotherapy and Lifestyle Recommendations Among Hemodialyzed Patients and Kidney Transplant Recipients

Abstract

Success in treatment with hemodialysis (HD) and kidney transplantation (KTx) requires good adherence. The objective of this study was to evaluate adherence to pharmacotherapy and health recommendations among HD and KTx patients using subjective and objective measures. Two hundred thirty-nine enrolled patients, with 132 KTx (39F, 93M) and 107 HD (48F, 59M) completed a questionnaire regarding over-the-counter (OTC) medications and dietary supplements (DS), adherence to pharmacotherapy, lifestyle recommendations, and self-evaluation of knowledge on them. The surveys were supplemented with objective data from patients' medical records, including interdialytic weight gain and laboratory parameters. About 42.1% HD and 39.4% KTx patients reported using OTC medications without medical consultation (P=.677); 43.9% HD and 31.1% KTx used DS (P=.040); more HD than KTx failed to notify a doctor about it (52.2% vs. 21.4%; P<.001). More HD patients skipped medication doses (33.6% vs. 9.7%; P<.001). About 40.2% HD and 20.5% KTx patients drank alcohol (P<.001), 22.4% HD and 10.5% KTx smoked (P=.013). About 46.7% HD and 66.4% KTx patients limited their caloric intake (P=.002), 73.8% HD and 84.9% KTx limited their salt intake (P=.030). HD patients drank 1.17±0.57L of fluids daily and KTx drank 2.51±0.67L (P<.001). In HD patients, interdialytic weight gains positively correlated with dialysis vintage (R=0.26, P=.02) and fluid (R=0.28, P=.011) but not salt intake (P=.307). The variability of trough levels of calcineurin inhibitors was unrelated to use of DS or OTC medications. KTx rated their knowledge on recommendations higher compared with HD (mean score 4.0±1.0 vs. 3.7±1.0, P=.040). KTx recipients exhibit better adherence and rate their knowledge on recommendations higher than HD patients.