Department of Geriatric Medicine and Nephrology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.
Clin Exp Nephrol. 2013 Apr;17(2):310-5. doi: 10.1007/s10157-012-0713-4. Epub 2012 Oct 23.
Nonadherence to treatment regimens for immunosuppressive agents is one of the major risk factors for allograft failure in kidney transplant recipients. The aim of this study was to estimate the relative effect of daily dosing on treatment adherence, not to identify how patients are non-adherent, in long-term kidney transplant recipients.
In January 2009, a cross-sectional, anonymous, and voluntary questionnaire survey was given to kidney transplant recipients who regularly visited Inoue Hospital. A self-reporting questionnaire underestimates nonadherence, but we reasoned that the effect of the dosing regimen should be estimated with relative accuracy by using the generalized ordered logit/partial proportional hazard odds model given that the distribution patterns in the degree of nonadherence have been shown to be similar with other measures.
Of 336 eligible patients, 312 (92.9 %) participated in this study. Two hundred seventy-four patients (87.8 %) were more than 3 years post-transplant. Univariate analysis revealed that a single daily dose was significantly associated with better adherence. After controlling for age, sex, time since transplantation, and the number of prescribed drugs, the effect of a single daily dose still remained significant [odds ratio, 0.40 (95 % confidence interval, 0.19-0.81); p = 0.011]. Several sensitivity analyses yielded similar results.
To our knowledge, this is the first report that, in long-term kidney transplant recipients, a single daily regimen-one of few modifiable factors-might improve treatment adherence and allograft survival.
对于接受肾移植的患者而言，不遵守免疫抑制剂治疗方案是导致移植物失功的主要风险因素之一。本研究旨在评估每日剂量对治疗依从性的相对影响，而非确定长期肾移植受者不依从的原因。
2009 年 1 月，对定期到猪饲医院就诊的肾移植受者进行了横断面、匿名和自愿问卷调查。尽管自报告问卷可能低估了不依从的情况，但我们认为，鉴于其他措施已表明不依从程度的分布模式相似，使用广义有序逻辑/部分比例风险优势模型估计剂量方案的效果应该具有相对准确性。
在 336 名符合条件的患者中，有 312 名（92.9%）参与了本研究。274 名患者（87.8%）接受移植的时间超过 3 年。单因素分析显示，每日一次剂量与更好的依从性显著相关。在校正年龄、性别、移植后时间和规定药物数量后，单次每日剂量的作用仍然显著[优势比，0.40（95%置信区间，0.19-0.81）；p=0.011]。几项敏感性分析得出了相似的结果。
据我们所知，这是第一项报告，在长期肾移植受者中，每日一次的方案（少数可改变的因素之一）可能改善治疗依从性和移植物存活率。
