Medication compliance and lifestyle adherence in renal transplant recipients in Kuwait

Figures & data

Table 1 Questions and rating system of medication compliance questionnaire

Questions	Always	Most of the time	Sometimes	Never
I take my medicines everyday	3	2	1	0
I take my medicines on time (as scheduled)	3	2	1	0
I always have my medicines even outside the country	3	2	1	0
I do not forget taking my medicines	3	2	1	0
I know the names, colors, and shapes of my medicines	3	2	1	0
I do not skip my dose if I feel better	3	2	1	0

Table 2 Patients’ demographic data

	Male (%)	Female (%)	Total (%)
Number	99 (82.5)	21 (17.5)	120 (100)
Nationality
Kuwaiti	57 (47.5)	14 (11.7)	71 (59.2)
Non-Kuwaiti	42 (35)	7 (5.8)	49 (40.8)
Age
Less than 40	43 (35.8)	12 (10)	55 (45.8)
More than 40	56 (46.7)	9 (7.5)	65 (54.2)
Follow up after Transplant
Less than 3 years	26 (21.7)	3 (2.5)	29 (24.2)
3–8 years	21 (17.5)	0 (0)	21 (17.5)
More than 8 years	52 (43.3)	18 (15)	70 (58.3)
Marital status
Married	65 (54.2)	12 (10)	77 (64.2)
Single	29 (24.2)	6 (5)	35 (29.2)
Divorced	3 (2.5)	2 (1.7)	5 (4.2)
Widowed	2 (1.6)	1 (0.8)	3 (2.4)
Number of children
Before Transplant	55	17	72
After Transplant	12	0	12

Table 3 Pre- and post-transplant patients’ co-morbidities and Immunosuppressants

Characteristics	Patient (%)
Dialysis Type
Hemodialysis	108 (90)
Peritoneal Dialysis	5 (4.2)
Both	0 (0)
None	7 (5.8)
Dialysis Duration
Less than 1 year	86 (71.7)
More than 1 year	27 (28.3)
Donor source
Living related	35 (29.2)
Living emotionally related	85 (70.8)
Post-Transplant complications
Diabetes	15 (12.5)
Hypertension	33 (27.5)
chest infections	27 (22.5)
Tumors	2 (1.7)
Hepatitis C	2 (1.7)
Coronary Heart Disease	2 (1.7)
Dyslipidemia	5 (4.2)
Total Diabetic Patients	45 (37.5)
Total Hypertensive patients	101 (84.2)
Graft rejections (Total)
Yes	31 (25.8)
No	89 (74.2)
Male sexual complications
Erectile dysfunction	19 (19.2)
Premature ejaculation	9 (9.1)
Both	17 (17.2)
Menstrual cycle regularity
Regular	13 (61.9)
Irregular	8 (38.1)
Immunosuppressants
Prednisolone	105 (87.5)
Tacrolimus	83 (69.2)
Cyclosporine	24 (20)
Sirolimus	8 (6.7)
Mycophenolate mofetil	56 (46.7)
Mycophenolate sodium	54 (45)
Azathioprine	4 (3.3)

Table 4 Factors affecting compliance and their significance

Factors	Compliant (%)	Partially compliant (%)	Poorly compliant (%)	P-Value
Nationality
Kuwaiti	36 (50.7)	21 (29.6)	14 (19.7)	0.038
Non-Kuwaiti	36 (73.5)	9 (18.4)	4 (8.1)
Gender
Male	67 (67.7)	21 (21.2)	11 (11.1)	0.001
Female	5 (23.8)	9 (42.9)	7 (33.3)
Follow up after Transplant
Less than 3 years^a	21 (72.4)	3 (10.4)	5 (17.2)	0.004
3–8 years^b	18 (85.7)	1 (4.7)	2 (9.6)
More than 8 years^a,b	33 (47.1)	26 (37.1)	11 (15.8)
Marital status
Married	51 (66.2)	18 (23.4)	8 (10.4)	0.186
Single	19 (54.2)	8 (22.9)	8 (22.9)
Divorced	2 (40)	2 (40)	1 (20)
Widowed	0 (0)	2 (66.7)	1 (33.3)
Education level
Ignorant^a	1 (20)	3 (60)	1 (20)	0.69
Can Read and write	14 (60.9)	5 (21.7)	4 (17.4)
High school graduate^b	29 (55.8)	11 (21.1)	12 (23.1)
University Graduate^a,b	28 (70)	11 (27.5)	1 (2.5)
Occupation
No work	31 (52.5)	17 (28.8)	11 (18.7)	0.234
Commercial	19 (82.6)	3 (13)	1 (4.4)
Administrative	16 (51.6)	10 (32.3)	5 (16.1)
Professional	2 (100)	0 (0)	0 (0)
Manual work	4 (80)	0 (0)	1 (20)
Income
Sufficient	51 (58)	22 (25)	15 (17)	0.804
Not sufficient	9 (60)	4 (26.7)	2 (13.3)
More than enough	12 (70.6)	4 (23.5)	1 (5.9)
Dialysis Duration
Less than 1 year	46 (53.5)	24 (27.9)	16 (18.6)	0.092
More than 1 year	20 (74.1)	6 (22.2)	1 (3.7)
Donor source
Living, Unrelated	47 (55.3)	21 (24.7)	17 (20)	0.04
Living, related	26 (74.3)	8 (22.8)	1 (2.9)
Age
Less than 40	30 (54.5)	12 (21.9)	13 (23.6)	0.047
40 or more	45 (69.2)	15 (23.1)	5 (7.7)

Notes: ^aShared superscripts are significant. ^bShared superscripts are significant.

Table 5 Types of diets and patient compliance

Diet Type	Compliance, n (%)
Without salt	19 (15.8)
Low salt	39 (32.5)
Low fat	20 (16.7)
Low sugar	21 (17.5)
Low protein	4 (3.3)
Calcium rich	57 (47.5)
Low carbohydrates	30 (25)

Table 6 Medical checkup and laboratory results (medication compliance)

	Compliant	Partially compliant	Poorly compliant	P-value
Number of daily medications	9 (±3)	9 (±4)	10 (±4)	0.8
Height (cm)	169.88 (±12.55)^a	165.73 (±9.5)	162.44 (±12.63)^a	0.04
Weight (kg)	80.17 (±14.08)^a	77.69 (±16.97)	71.44 (±20.29)^a	0.12
Temperature (°C)	36.7 (±0.29)	36.7 (±0.37)	36.8 (±0.29)	0.3
Pulse (per minute)	76 (±9)	74 (±5)	75 (±7)	0.7
Systolic BP (mmHg)	128 (±14)	134 (±15)	131 (±11)	0.2
Diastolic BP (mmHg)	77 (±8)	79 (±10)	80 (±11)	0.33
Creatinine (umol/L)	155.5 (±75.64)^a	183.37 (±115.33)	204 (±88.03)^a	0.07
Phosphorous (mmol/L)	1.17 (±0.25)	1.18 (±0.3)	1.15 (±0.19)	0.92
Calcium (mmol/L)	2.29 (±0.12)^a	2.18 (±0.22)^a	2.23 (±0.09)	0.01
Bilirubin (umol/L)	9.54 (±5.81)^a	7.45 (±2.46)^a	8.29 (±1.81)	0.12
Cholesterol (mmol/L)	4.71 (±0.98)^a	4.43 (±0.19)^b	5.32 (±0.69)^a,b	0.01
Glucose (fasting) (mmol/L)	6.55 (±2.75)	6.07 (±1.79)	5.36 (±1.9)	0.17
Albumin (g/L)	35.4 (±5.41)	35.83 (±10.65)	35.25 (±3.99)	0.94
Uric acid (umol/L)	354.75 (±135.4)^a	303.13 (±93.34)^a	303.28 (±75.45)	0.07
Potassium (mmol/L)	4.46 (±0.46)	4.39 (±0.44)	4.53 (±0.34)	0.55
Haemoglobin (g/dl)	12.37 (±1.7)^a,b	11.3 (±1.71)^a	10.81 (±1.79)^b	0.001
Hematocrit	0.37 (±0.06)^a,b	0.34 (±0.05)^a	0.33 (±0.04)^b	0.001
WBC (x10^9 cells per liter)	7.71 (±2.71)^a	7.71 (±1.97)^b	6.21 (±1.18)^a,b	0.05
Platelets (x10^9 per liter)	249 (±81)	220 (±85)	250 (±72)	0.23
Tacrolimus (ng/mL)	6.46 (±2.25)	5.89 (±1.42)	6.15 (±0.94)	0.55

Notes: ^aShared superscripts are significant at the 0.05 level. ^bShared superscripts are significant at the 0.05 level.

Table 7 Graft rejection and transplant complications after transplant

Medication compliance	Graft rejection		P-Value
	Yes (%)	No (%)
Compliant^a	14 (19.4)	58 (80.6)	0.045
Partial	11 (36.7)	19 (63.3)
Poor^a	8 (44.4)	10 (55.6)
	Transplant complications
	Yes (%)	No (%)
Compliant^a,b	25 (34.7)	47 (65.3)	0.003
Partial^a	20 (66.7)	10 (33.3)
Poor^b	12 (66.7)	6 (33.3)
	Second Transplant
	Yes (%)	No (%)
Compliant^a	5 (6.9)	67 (93.1)	0.026
Partial^a	8 (26.7)	22 (73.3)
Poor	3 (16.7)	15 (83.3)

Notes: ^aShared superscripts are significant. ^bShared superscripts are significant.