Abstract
Background. Nonadherence to medication is a common problem after kidney transplantation. The aim of this study was to explore attitudes towards medication, adherence, and the relationship with clinical outcomes. Method. Kidney recipients participated in a Q-methodological study 6 weeks after transplantation. As a measure of medication adherence, respondents completed the Basel Assessment of Adherence to Immunosuppressive Medications Scale (BAASIS©-interview). Moreover, the intrapatient variability in the pharmacokinetics of tacrolimus was calculated, which measures stability of drug intake. Data on graft survival was retrieved from patient records up to 2 years after transplantation. Results. 113 renal transplant recipients (19–75 years old) participated in the study. Results revealed three attitudes towards medication adherence—attitude 1: “confident and accurate,” attitude 2: “concerned and vigilant,” and attitude 3: “appearance oriented and assertive.” We found association of attitudes with intrapatient variability in pharmacokinetics of tacrolimus, but not with self-reported nonadherence or graft survival. However, self-reported nonadherence immediately after transplantation was associated with lower two-year graft survival. Conclusion. These preliminary findings suggest that nonadherence shortly after kidney transplantation may be a risk factor for lower graft survival in the years to follow. The attitudes to medication were not a risk factor.
Highlights
Kidney transplant patients are required to take lifelong immunosuppressive medication to prevent graft rejection
On average 36% of patients per year are reported to be nonadherent to immunosuppressive medication with estimates ranging from 2 to 67% [2, 5,6,7]
Between August, 2010, and October, 2011, 212 kidney transplantations were carried out in our centre. Of these 212 patients 44 were excluded for the following reasons: inability to speak the Dutch language sufficiently (n = 23), a mental or physical disability (n = 9), death prior to inclusion (n = 4), graft loss (n = 4), primary nonfunction (n = 3), and follow-up at another centre (n = 1)
Summary
Kidney transplant patients are required to take lifelong immunosuppressive medication to prevent graft rejection. Nonadherence to immunosuppressive medication is a common issue and increases over time. On average 36% of patients per year are reported to be nonadherent to immunosuppressive medication with estimates ranging from 2 to 67% [2, 5,6,7]. Nonadherence to medication is a common problem after kidney transplantation. We found association of attitudes with intrapatient variability in pharmacokinetics of tacrolimus, but not with self-reported nonadherence or graft survival. Self-reported nonadherence immediately after transplantation was associated with lower two-year graft survival. These preliminary findings suggest that nonadherence shortly after kidney transplantation may be a risk factor for lower graft survival in the years to follow.
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