Abstract
Purpose
The aim of this study was to determine the prevalence of nonadherence in a cohort of renal transplant recipients (RTRs) and to evaluate prospectively whether more intense clinical surveillance and reduced pill number enhanced adherence.
Patients and methods
The study was carried out in 310 stable RTRs in whom adherence, life satisfaction, and transplant care were evaluated by specific questionnaires (time 0). The patients under tacrolimus (TAC; bis in die [BID]) were then shifted to once-daily TAC (D-TAC) to reduce their pill burden (Shift group) and were followed up for 6 months to reevaluate the same parameters. Patients on cyclosporin or still on BID-TAC constituted a time-control group.
Results
The prevalence of nonadherence was 23.5% and was associated with previous rejection episodes (P<0.002), and was inversely related to Life Satisfaction Index, anxiety, and low glomerular filtration rate (minimum P<0.03). Nonadherent patients were significantly less satisfied with their medical care and their relationships with the medical staff. A shift from BID-TAC to D-TAC was performed in 121 patients, and the questionnaires were repeated after 3 and 6 months. In the Shift group, a reduction in pill number was observed (P<0.01), associated with improved adherence after 3 and 6 months (+36%, P<0.05 versus basal), with no change in controls. Decreased TAC trough levels after 3 and 6 months (−9%), despite a slight increase in drug dosage (+6.5%), were observed in the Shift group, with no clinical side effects.
Conclusion
The reduced pill burden improves patients’ compliance to calcineurin-inhibitors, but major efforts in preventing nonadherence are needed.
Supplementary material
The transplant learning center indices
Life satisfaction index
Please rate your satisfaction with each of the following in your life within the last month:
Your overall health
Your relationship with the people who provide your medical care
The health care you have received
Your relationship with your spouse/partner
Your ability to do things for yourself
Your appearance
The amount of control you have over your life
Your life in general.
Five-item scale (0–4, very dissatisfied–very satisfied); maximum score 32, with higher scores denoting a better quality of life.
Transplant care index
Please rate the level of difficulty you have with the following:
Keeping your scheduled follow-up visits
Following a regular exercise program
Following a healthy and balanced diet
Having your tests done as scheduled
Taking all of your medicines as prescribed
Dealing with the side effects of your medicines.
Five-item scale (0–4, very difficult–very easy); maximum score 24, with higher scores denoting easier transplant care.
Disclosure
The authors report no conflicts of interest in this work.