Abstract
BackgroundAdherence is the result of the interaction of the macro, meso, micro, and patient level factors. The macro level includes full coverage of immunosuppressive medications as is the case in Brazil. We studied the correlates of immunosuppressive non-adherence in post kidney transplant patients in the Brazilian health care system.MethodsUsing a cross-sectional design, adherence to immunosuppressives was assessed in a sample of 100 kidney transplant patients using a composite non-adherence score consisting of three methods (self-report [i.e., The Basel Adherence Scale for Assessment of Immunossupressives–BAASIS], collateral report, and immunosuppressive blood levels). Multilevel correlations of non-adherence were assessed (macro, meso, micro and patient level). Univariate and multivariate logistic regression was applied to assess the correlates of non-adherence.ResultsOur sample consisted primarily of male (65%), Caucasians (72%) with a mean age of 45.0 ± 13.5 years old, who received grafts from a living donor (89%), with a mean time after transplantation of 72.3 ± 44.4 months. Prevalence of non-adherence was 51%. Family income higher than five reference wages (21.6 vs. 4%; OR 6.46 [1.35–30.89], p = 0.009; patient level), and having access to private health insurance (35.3% vs. 18.4%; OR 2.42 [0.96–6.10], p = 0.04; meso level) were associated with non-adherence in univariate analysis. Only the higher family income variable was retained in the multiple logistic regression model (OR 5.0; IC: 1.01–25.14; p = 0.04).ConclusionsHigher family income was the only factor that was associated with immunosuppressive non-adherence. In Brazil, lower income recipients benefit from better access to care and coverage of health care costs after transplantation. This is supposed to result in a better immunosuppressive adherence compared to high-income patients who have experienced these benefits continuously.
Highlights
Kidney transplant (KTx) is considered the best therapeutic option for patients with chronic kidney disease (CKD), both from a clinical and economic point of view [1]
Multilevel Correlates to Non-Adherence in Kidney Transplantation
Higher family income was the only factor that was associated with immunosuppressive nonadherence
Summary
Kidney transplant (KTx) is considered the best therapeutic option for patients with chronic kidney disease (CKD), both from a clinical and economic point of view [1]. In terms of preserving long-term graft function and reducing the risk of complications, KTx recipients have to adhere to a lifelong immunosuppressive regimen since non-adherence (NA) is associated with poor clinical and economic outcomes [2,3,4,5]. Non-adherent patients have a 7 fold increased risk of graft loss [7,8,9]. Adherence is the result of the interaction of the macro, meso, micro, and patient level factors. We studied the correlates of immunosuppressive non-adherence in post kidney transplant patients in the Brazilian health care system
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