kidney transplantation

Non-adherence to medications among kidney transplantation patients in two large transplant centers in the USA was found to be due to limited literacy in 25% of the patients. Among other factors that played a role in non-adherence were frequent medication changes in 33%, belonging to a minority race and earning a lower income.

 

It is estimated that non-adherence results in 125,000 deaths per year and 33 – 69% of hospital admissions among patients admitted for various indications.  Among patients who are the recipients of kidneys, health literacy and medical forgetfulness have been correlated to non-adherence; however, risk factors for unintentional non-adherence such as frequency of dosing, medication changes, complexity of medication regimens and medical knowledge have not been elucidated. To examine these risk factors, Rachel Patzer at Emory University School of Medicine and collaborators conducted in-person, structured interviews and employed electronic medical records to examine associations between kidney transplant recipient’s risk factors and clinical outcomes over a 12-month period.

There is a seven-fold higher risk of graft failure and a three-fold higher risk of late acute rejection episodes in non-adherent individuals and it is estimated that the rejection rate is 35% in kidney recipients.  Taking multi-drug regimens require substantial cognitive and behavioral competencies, which impact overall adherence and health outcomes. In this study, the authors described the prevalence of medication self-management measured by multiple steps including failure to fill medications, inability to identify medication, inappropriate dosing frequency, incorrect dosage, misinterpretation of medication warnings and lastly sustaining medication behaviors indefinitely. To achieve this aim, the authors recruited 99 individuals with a mean age of 52.5 years from two different sites. Interestingly, while 46.5% were college graduates and 86.9% were cognitively unimpaired, 67.7% reported medication changes.

Bivariate analysis of risk factors showed that minority patients reported an 8-point lower knowledge score compared to patients of Caucasian ancestry. Statistically significant associations were also observed between patients with more medications, limited health literacy and cognitive impairment resulting in decreased knowledge of treatment. Multivariate analysis showed that higher odds of medication non-adherence were associated with patients within 12 months since transplant and limited health literacy.

This study assessed kidney transplant patient’s understanding of their entire medication regimen and determined the associations between treatment knowledge, regimen use and clinical outcomes while identifying important socio-demographic, cognitive and clinical factors that influence medication non-compliance, non-adherence and hospitalization among kidney transplant recipients. Barriers that impede adherence are socio-demographic, disease related, drug-related, patient-related and psychological. Addressing these can significantly reduce non-adherence from its current prevalence of a high of 58.7%.

 

Written By: Joseph M. Antony, PhD

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