Department of Internal Medicine and Transplant Nephrology, Medical University of Lodz, Poland.
Department of Internal Medicine and Transplant Nephrology, Medical University of Lodz, Poland; Department of Biostatistics and Translational Medicine, Medical University of Lodz, Poland.
J Ren Nutr. 2021 Sep;31(5):503-511. doi: 10.1053/j.jrn.2020.12.006. Epub 2021 Feb 26.
Success in treatment with hemodialysis (HD) and kidney transplantation (KTx) requires good adherence. The objective of this study was to evaluate adherence to pharmacotherapy and health recommendations among HD and KTx patients using subjective and objective measures.
Two hundred thirty-nine enrolled patients, with 132 KTx (39F, 93M) and 107 HD (48F, 59M) completed a questionnaire regarding over-the-counter (OTC) medications and dietary supplements (DS), adherence to pharmacotherapy, lifestyle recommendations, and self-evaluation of knowledge on them. The surveys were supplemented with objective data from patients' medical records, including interdialytic weight gain and laboratory parameters.
About 42.1% HD and 39.4% KTx patients reported using OTC medications without medical consultation (P = .677); 43.9% HD and 31.1% KTx used DS (P = .040); more HD than KTx failed to notify a doctor about it (52.2% vs. 21.4%; P < .001). More HD patients skipped medication doses (33.6% vs. 9.7%; P < .001). About 40.2% HD and 20.5% KTx patients drank alcohol (P < .001), 22.4% HD and 10.5% KTx smoked (P = .013). About 46.7% HD and 66.4% KTx patients limited their caloric intake (P = .002), 73.8% HD and 84.9% KTx limited their salt intake (P = .030). HD patients drank 1.17 ± 0.57 L of fluids daily and KTx drank 2.51 ± 0.67 L (P < .001). In HD patients, interdialytic weight gains positively correlated with dialysis vintage (R = 0.26, P = .02) and fluid (R = 0.28, P = .011) but not salt intake (P = .307). The variability of trough levels of calcineurin inhibitors was unrelated to use of DS or OTC medications. KTx rated their knowledge on recommendations higher compared with HD (mean score 4.0 ± 1.0 vs. 3.7 ± 1.0, P = .040).
KTx recipients exhibit better adherence and rate their knowledge on recommendations higher than HD patients.
血液透析（HD）和肾移植（KTx）治疗的成功需要良好的依从性。本研究的目的是使用主观和客观措施评估 HD 和 KTx 患者对药物治疗和健康建议的依从性。
239 名入组患者中，132 名 KTx（39 名女性，93 名男性）和 107 名 HD（48 名女性，59 名男性）完成了一份关于非处方（OTC）药物和膳食补充剂（DS）、药物治疗依从性、生活方式建议以及对这些建议的自我评估的问卷。调查结果通过患者病历中的客观数据进行补充，包括透析间体重增加和实验室参数。
约 42.1%的 HD 和 39.4%的 KTx 患者报告在没有医疗咨询的情况下使用 OTC 药物（P=.677）；43.9%的 HD 和 31.1%的 KTx 使用 DS（P=.040）；与 KTx 患者相比，更多的 HD 患者未通知医生（52.2%对 21.4%；P<.001）。与 KTx 患者相比，更多的 HD 患者漏服药物（33.6%对 9.7%；P<.001）。约 40.2%的 HD 和 20.5%的 KTx 患者饮酒（P<.001），22.4%的 HD 和 10.5%的 KTx 吸烟（P=.013）。约 46.7%的 HD 和 66.4%的 KTx 患者限制热量摄入（P=.002），73.8%的 HD 和 84.9%的 KTx 患者限制盐的摄入（P=.030）。HD 患者每天饮用 1.17±0.57 升液体，KTx 患者饮用 2.51±0.67 升（P<.001）。在 HD 患者中，透析间体重增加与透析时间（R=0.26，P=0.02）和液体（R=0.28，P=0.011）呈正相关，但与盐摄入无关（P=0.307）。钙调磷酸酶抑制剂的谷浓度变异性与使用 DS 或 OTC 药物无关。与 HD 患者相比，KTx 患者对建议的了解程度评分更高（平均评分为 4.0±1.0 对 3.7±1.0，P=.040）。
KTx 受者的依从性更好，对建议的了解程度评分高于 HD 患者。
