Abstract
ABSTRACTOBJECTIVE To estimate the prevalence and variability of nonadherence to immunosuppressives and nonpharmacological treatment across kidney transplantation centers and two health access-disparate regions in Brazil.METHODS In a cross-sectional design, a random multistage sample of 1,105 patients was included, based on center transplantation activity (low/moderate/high) and region (R1: North/Northeast/Mid-West; and R2: South/Southeast). Nonadherence to immunosuppressives (implementation phase) was assessed using the Basel Assessment of Adherence to Immunosuppressive Medications Scale (BAASIS)©. Self-report questionnaires assessed nonadherence to physical activity, smoking cessation, alcohol intake, and appointment keeping. We compared regions using the adjusted-χ2 or t-test.RESULTS Most patients were men (58.5%), white (51.4%), and had a mean age of 47.5 (SD = 12.6) years. Regarding kidney transplantation centers, 75.9% were from R2 and 38.2% had low activity. The patients in R2 were older, white-majority, had more frequently steady partners, and received peritoneal dialysis. Nonadherence to immunosuppressives ranged from 11–65.2%; 44.5–90% to physical activity; 0–23.7% to appointment keeping; and 0–14% to smoking cessation. The total prevalence of nonadherence and by region (R1 versus R2) were: for immunosuppressives, 39.7% (44.9% versus 38.1%, p = 0.18); for smoking, 3.9% (1% versus 5%, p < 0.001); for physical activity, 69.1% (71% versus 69%, p = 0.48); for appointment keeping, 13% (12.7% versus 12%, p = 0.77); and for alcohol consumption, 0%.CONCLUSION Despite differences among centers and high variability, only the nonadherence to smoking cessation was higher in the region with greater access to kidney transplantation. We suppose that differences in healthcare access may have been overcome by other positive aspects of the post kidney transplantation treatment.
Highlights
After kidney transplantation (KT), it is essential that transplant patients, who are considered chronically ill, adequately follow the proposed treatment to reduce the risks of graft rejection and the progression of existing comorbidities, and the development of new ones
Nonadherence to immunosuppressives ranged from 11–65.2%; 44.5–90% to physical activity; 0–23.7% to appointment keeping; and 0–14% to smoking cessation
Despite differences among centers and high variability, only the nonadherence to smoking cessation was higher in the region with greater access to kidney transplantation
Summary
After kidney transplantation (KT), it is essential that transplant patients, who are considered chronically ill, adequately follow the proposed treatment to reduce the risks of graft rejection and the progression of existing comorbidities, and the development of new ones. KT treatment is complex and involves adherence to immunosuppressives and nonpharmacological treatment components (regular physical activity, smoking cessation, reducing alcohol intake, and appointment keeping)[1,2,3]. The prevalence is 2.8–4.0 cases per 100 patients per year[7] This behavior is associated with cardiovascular diseases, and smoking cessation is recommended upon the diagnosis of chronic kidney disease[10]. Concerning alcohol consumption, post-transplant abuse is associated with poor medication adherence, which may increase the risk of graft loss and death[11]. Another fundamental but rarely studied behavior is the frequency of appointment keeping. Ranging from 2.5 to 14.6%, nonadherent patients had a 1.5-fold increased risk of acute rejection and a 65% higher chance of graft loss[7,12]
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