Distress associated with adverse effects of immunosuppressive medication in kidney transplant recipients.

CONTEXT

For kidney transplant patients, a lifelong intake of medication is mandatory. Health care workers' prioritization of adverse effects often differs from that of their patients, although patients' experience of adverse effects of medication can trigger nonadherence. Understanding how patients experience symptoms is therefore important.

OBJECTIVE

To present a new method to be used in research to evaluate symptom experience related to adverse effects in adult kidney transplant recipients on maintenance immunosuppressive therapy.

DESIGN

Cross-sectional secondary data analysis.

PATIENTS AND SETTING

Three hundred fifty-six adult kidney transplant recipients from 2 Swiss transplant outpatient clinics.

MAIN OUTCOME MEASURES

Symptom experience was measured with the Modified Transplant Symptom Occurrence and Symptom Distress Scale. For each item, ridit scores were calculated. A coordinate system with occurrence and distress ratings of each symptom classified symptoms into 4 quadrants: symptoms could have high occurrence/high distress, low occurrence/high distress, high occurrence/low distress, and low occurrence/low distress symptoms. Items farther from the origin represented more extreme profiles.

RESULTS

The proposed method arranges symptoms clearly in sequence of their importance. In our study, fatigue and joint and back pain were the most frequent and distressing symptoms. Symptom profiles for men and women differed: for men impotence and anxiety were key whereas for women listlessness and changed appearance seemed to play important roles.

CONCLUSIONS

The 2-dimensional diagram of symptom profiles enables researchers and clinicians to evaluate the impact of symptoms associated with immunosuppressive medications.