Factors Associated With Adherence To Immunosuppressive Therapy And Barriers In Asian Kidney Transplant Recipients

Figures & data

Table 1 Demographics Of Participants (n=244)

Age (Mean±SD)	39.6±12
Gender N (%)
Female	106 (43.4)
Male	138 (56.6)
Marital status N (%)
Single	69 (28.3)
Married	175 (71.7)
Education level N (%)
Elementary	80 (32.8)
Under high school	40 (16.4)
High school	84 (34.4)
Academic	40 (16.4)
Occupation N (%)
Employed	52 (21.3)
Retired	42 (17.2)
Unemployed	89 (36.5)
Temporarily unemployed	61 (16.4)
Donor N (%)
Alive	98 (40.2)
Deceased	146 (59.8)
Immunosuppressant drugs N (%)
Cyclosporine	170 (69.7)
Sirolimus	87 (35.5)
Prednisolone	146 (59.8)
Tacrolimus	99 (40.5)
CellCept	156 (63.9)
Azathioprine	178 (72.9)
Duration of transplant (month) (mean±SD)	59±57

Note: Results presented as mean (±SD) or n (%).

Table 2 Non-Adherence Measured Using BAASIS (n=133)

Items	Answers	N (%) (n=133)	Total N (%)
In the previous 4 weeks, how often have you forgot to take your immunosuppressants?	Once per month	26 (19.5)	40 (30)
	Once per 2 weeks	7 (5.3)
	Every week	3 (2.3)
	More than once per week	4 (3)
	Every day	0 (0)
In the previous 4 weeks, how often have you forgot to take several consecutive doses of your immunosuppressants?	Once per month	14 (10.5)	22 (16.6)
	Once per two week	4 (3)
	Every week	3 (2.3)
	More than once per week	0 (0)
	Every day	1 (0.8)
In the previous 4 weeks, how often have you made at least 2 hrs delay in immunosuppressant intake?	Once per month	54 (40.6)	113 (86.7)
	Once per 2 weeks	24 (19)
	Every week	16 (12)
	More than once per week	15 (11.3)
	Every day	4 (3)
In the previous 4 weeks, have you reduced the dose of your immunosuppressants?	Once per month	14 (10.5)	21 (15.8)
	Once per 2 weeks	5 (3.8)
	Every week	2 (1.5)
	More than once per week	0 (0)
	Every day	0 (0)
How well have you performed in taking anti-rejection medications during the previous 4 weeks (minimum: 0 and maximum: 100)?^a	Non-adherent Adherent	7.72 (±1.98) 8.81 (±1.64)

Notes: Non-adherent patients answered yes to BAASIS questions 1a, 2, 3, or 4; otherwise, the patient was considered to be adherent. ^aResults from visual analogue scale presented as mean (±SD).

Table 3 Comparing Input Variable In Medication Non-Adherent And Adherent Patient Among Kidney Transplant Recipients (n=244)

		Medication Adherence
		Non-Adherence (N=133)	Adherence (N=111)	p-Value
Gender (%)	Female	49 (37)	57 (51)	0.020^b
	Male	84 (63)	54 (49)
Marital status (%)	Single	40 (28)	29 (26)	0.29^b
	Married	93 (70)	82 (74)
Education (%)	Elementary	39 (29)	41 (37)	0.15^b
	Under high school	26 (19.5)	14 (13)
	High school	42 (32)	42 (38)
	Academic	26 (19.5)	14 (12)
Occupation (%)	Employed	33 (25)	19 (17)	0.19^b
	Retired	25 (19)	17 (15)
	Unemployed	41 (30)	48 (43)
	Temporarily unemployed	34 (26)	27 (25)
Donor (%)	Alive	58 (44)	40 (36)	0.241^b
	Deceased	75 (56)	71 (64)
Age (mean±SD)		40±12	39±13	0.49^a
Time since transplantation(month) (mean±SD)		62±56.3	55.6±51.8	0.365^a
Duration of dialysis (month) (mean±SD)		29.15±27.6	26.3±19.6	0.358^a
Quality of life (mean±SD)		30.1±5.9	32.6±6.2	0.001^a
Knowledge of transplant (mean±SD)		40.97±6	40.6±6.8	0.705^a
Re-hospitalization N (%)
For increase creatinine		38 (28.6)	31 (28.2)	0.53^b
For proteinuria		4 (3)	4 (3.6)	0.53^b
For infection		50 (37.6)	38 (34.2)	0.34^b
Total of rehospitalization		71 (62)	53 (47)	0.29^b
Clinical outcome
Rejection (%)		6 (4.5)	2(1.8)	0.297^b
Creatinine (mean±SD)		1.91±1.3	1.7±1.01	0.273^a

Notes: ^aPerformed as a Independent sample t-test. ^bPerformed as a Chi-square.

Figure 1 Barriers to medication adherence: comparison of ITBS mean scores between adherent and non-adherent patient.

Table 4 Significant Barriers To Immunosuppressant Adherence

Barriers	Likert Scale	Medication Adherence
		Non-Adherence%	Adherence%	p-Value
I have to take too many capsules (or tablets) of my immunosuppressant medication(s) at the same time	Agree	96 (72.2)	68 (61.2)	0.05^a
	Neutral	9 (6.8)	7 (6.3)
	Disagree	28 (21.1)	36 (32.4)
I cannot tell if my immunosuppressant medication(s) is (are) helping me	Agree	113 (85)	49 (44.1)	0.009^a
	Neutral	10 (7.5)	13 (11.7)
	Disagree	10 (7.5)	49 (44.1)
I get confused about how to take my immunosuppressant medication	Agree	110 (83.5)	59 (53.1)	0.03^a
	Neutral	9 (6.8)	18 (16.2)
	Disagree	14 (10.5)	34 (10.6)
It is hard for me to remember to take my immunosuppressant medication(s)	Agree	116 (87.2)	37 (33.3)	0.0008^a
	Neutral	3 (2.3)	13 (11.7)
	Disagree	14 (10.6)	61 (54.9)

Note: ^aPerformed as a Chi-square.

Data Availability

The data used to support the findings of this study are restricted by the Ethics Committee of Mashhad University of Medical Sciences in order to protect patient privacy. Data are available from Saeid Eslami (corresponding author; [email protected]) for researchers who meet the criteria for access to confidential data.