Immunosuppressive therapy related adherence, beliefs and self-management in kidney transplant outpatients

Figures & data

Table 1 Sociodemographic, clinical, and medicine characteristics (n=211)

Characteristics
Gender, n (%)
Male (%)	123 (58.3)
Age (years)
Median (min, max)	57.0 (25–77)
Education, n (%)
Secondary school	22 (10.4)
High school	172 (81.5)
Post/undergraduate	17 (8.1)
Occupation, n (%)a
Active worker	65 (29.4)
Disability pension	76 (34.4)
Retirement pension	77 (34.8)
Hometown (inhabitants), n (%)
<10,000	143 (67.8)
Living alone, n (%)
Yes	43 (20.4)
Income per month (Czech crown), n (%)b
<30,000	140 (66.3)
Satisfaction with the income, n (%)
Yes	121 (57.3)
Time after KTx (months), n (%)
≤3	16 (7.6)
4–12	21 (10.0)
13–24	25 (11.8)
>24	149 (70.6)
Repeated transplants, n (%)
Yes	23 (10.9)
Type of donor, n (%)
Cadaveric	200 (94.8)
Living	11 (5.2)
Cause of renal failure, n (%)
Chronic glomerulonephritis	51 (24.2)
IgA nephropathy	32 (15.2)
Renal polycystosis	38 (18.0)
Family history of kidney disease, n (%)
Positive	55 (26.1)
Not available	22 (10.4)
Estimated glomerular filtration rate (mL/s), n (%)c
>1.5	4 (1.9)
1–1.5	45 (21.3)
0.5–1	130 (61.6)
<0.5	32 (15.2)
Medication, mean (SD)
Prescription	11.13±2.90
Over the counter	0.86±1.09
Immunosuppression, n (%)a
Tacrolimus	125 (59.2)
Cyclosporine	59 (28.0)
Sirolimus	30 (13.3)
Everolimus	2 (0.9)
Mycophenolate	169 (80.1)
Prednisone	201 (95.3)
Azathioprine	7 (3.3)
Knowledge of the IS name, n (%)a
Tacrolimus	105 (84.0)
Cyclosporine	47 (79.7)
Sirolimus/everolimus	24 (80.0)
Mycophenolate	117 (69.2)
Prednisone	77 (38.3)
Azathioprine	6 (85.7)
Perception of health condition, n (%)
Excellent	16 (7.6)
Very good	35 (16.6)
Good	113 (53.6)
Satisfying	41 (19.3)
Bad	6 (2.9)

Notes:

a Multiple answers possible;

b exchange rate on 12/04/2018: one euro =25.3 Czech crown;

c eGFR using CKD-EPI.

Abbreviations: IS, immunosuppression; KTx, kidney transplantation.

Table 2 Kendall’s correlations of self-reported adherence, beliefs, and IS serum levels with relevant sociodemographic and clinical characteristics (n=211)

Characteristics	MARS-CZ	Relative IS serum level1	BMQ-CZ, necessity	BMQ-CZ, concern
Age (years)	0.179**	0.001	0.141**	−0.0003
Age at KTx (years)	0.208***	−0.009	0.189***	−0.057
Time after KTx (months)	−0.124*	0.020	−0.090	0.101*
MARS, total		0.017	0.165**	−0.118*
Relative IS serum level1	0.017		0.022	0.029
BMQ, necessity	0.165**	0.022		−0.059
BMQ, concern	−0.118*	0.029	−0.059
Estimated glomerular filtration rate (mL/s)2	0.070	0.073	0.024	0.031
Number of medication per day	0.073	0.020	0.133*	0.086
Educational status	0.014	−0.082	−0.248***	0.055
Perception of health status	0.098	0.031	−0.099	−0.166**

Notes:

1 Target range for tacrolimus was 10–5 µg/L in newly transplanted and 5–10 µg/L in others; 80–120 nmol/L for cyclosporine and 4–9 µg/L for sirolimus;

2 eGFR using CKD-EPI.

* P<0.05;

** P<0.01;

*** P<0.001.

Abbreviations: BMQ-CZ, Beliefs about Medicines Questionnaire – Czech version; IS, immunosuppression; KTx, kidney transplantation; MARS-CZ, Medication Adherence Report Scale – Czech version.

Table 3 Self-management tasks (n=211)

Drug preparation and use
Taking pill with relation to food, n (%)
Tacrolimus on an empty stomach	43 (34.4)
Prednisone after breakfast	160 (79.6)
Liquid for swallowing the pill, n (%)
Only water or fruit tea	138 (65.4)
Green or black tea, milk, coffee, etc	73 (34.6)
Daily drug preparation, n (%)
Himself/herself	192 (91.0)
Family member	20 (9.5)
Nurse	1 (0.5)
Use of drug aids, n (%)
Pillbox	114 (54.0)
Medication list	119 (56.4)
None	63 (29.9)
Dietary habits, n (%)
Food avoidance1	92 (43.6)
Grapefruit, pomelo, and pomegranate consumption	68 (32.2)
Salt restriction	147 (69.7)
Lifestyle habits
Sun protection, n (%)
Sunblock cream	55 (26.1)
Proper clothes (eg, hat)	73 (34.6)
Avoiding sunshine (at noon)	110 (52.4)
Avoiding solarium	211 (100.0)
Nothing	58 (27.5)
Smoking, n (%)
Current smoker	24 (11.4)
Ex-smoker	58 (27.5)
Never smoked	129 (61.1)
Monitoring of blood pressure, n (%)
Regularly	114 (54.0)
When needed	44 (20.9)
By a practitioner	12 (5.7)
Week before medical appointment	2 (0.9)
None	39 (18.5)
Monitoring of body weight, n (%)	159 (79.1)
Preventive examination, n (%)2
Influenza vaccine	42 (19.9)
Pneumococcal vaccine	5 (2.4)
Bone densitometry	49 (23.2)

Notes:

1 Individual restriction of any kind of nourishment;

2 Individual awareness of selected preventive examination.

Figure 1 Serum levels of main immunosuppressives.

Abbreviations: CYSP, cyclosporine; SIR, sirolimus; TAC, tacrolimus.