Abstract
ObjectiveEstimates indicate that 20–70% of renal transplant recipients are medication non-adherent, significantly increasing the risk of organ rejection. Medication adherence is negatively impacted by lower everyday problem solving ability, and associations between depressive symptoms, self-efficacy, and adherence are reported in renal transplant recipients. Nonetheless, to date, these associations have not been examined concurrently. Given the relationship between non-adherence and organ rejection, it is critical to gain a better understanding of the predictors of adherence in renal transplant recipients. To this end, we modeled relationships among cognitive abilities, depressive symptoms, self-efficacy, and adherence in this group.MethodsParticipants (N = 211) underwent renal transplant at least one year prior to participation. Adherence was measured via self-report, medication possession ratio, and immunosuppressant blood-level. Traditionally-measured neurocognitive and everyday problem-solving abilities were assessed. Depressive symptoms were measured via self-report, as were general and medication adherence related self-efficacy. Structural equation modeling was used to assess the fit of the model to available data.ResultsEveryday problem solving and self-efficacy had direct positive associations with adherence. Depressive symptoms were negatively associated with self-efficacy, but not adherence. Traditionally-measured neurocognitive abilities were positively associated with self-efficacy, and negatively associated with depressive symptoms.ConclusionsWe present a comprehensive investigation of relationships between cognitive and psychosocial factors and adherence in medically stable renal transplant recipients. Findings confirm the importance of everyday problem solving and self-efficacy in predicting adherence and suggest that influences of depressive symptoms and neurocognitive abilities are indirect. Findings have important implications for future development of interventions to improve medication adherence in renal transplant recipients.
Highlights
Failing to adhere to immunosuppressant medications by renal transplant recipients (RTR) is associated with elevated morbidity and mortality [1]
We present a comprehensive investigation of relationships between cognitive and psychosocial factors and adherence in medically stable renal transplant recipients
Relative to their healthy peers, adults with chronic kidney disease (CKD) demonstrate weaknesses in memory and executive functioning across the course of their illness [7,8] and following successful transplant [9,10]. These cognitive difficulties in CKD and RTR have been theorized to stem from cerebrovascular insufficiencies commonly reported in CKD and in dialysis patients that may not be reversed with transplantation [11]
Summary
Failing to adhere to immunosuppressant medications by renal transplant recipients (RTR) is associated with elevated morbidity and mortality [1]. Social factors such as living alone and being unmarried have previously been associated with decreased adherence, as have perceived low level of social support, external locus of control, beliefs that medications are not required, and higher levels of anxiety and hostility [6] Another risk factor that remains relatively understudied to date involves the role of cognition. Relative to their healthy peers, adults with chronic kidney disease (CKD) demonstrate weaknesses in memory and executive functioning across the course of their illness [7,8] and following successful transplant [9,10]. These cognitive difficulties in CKD and RTR have been theorized to stem from cerebrovascular insufficiencies commonly reported in CKD and in dialysis patients that may not be reversed with transplantation [11]
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