Oliveira Luana Cristina Lins de Medeiros, Tavares Raquel Padilha Martins, Moreira Francisca Sueli Monte, Nóbrega Ítala Morgânia Farias da, Nogueira Telma Cristiane Cavalcanti, Oliveira Alene Barros de, Batista Lorena de Medeiros, Martins Rand Randall, Oliveira Antonio Gouveia
Graduate Program in Pharmaceutical Sciences, Centro de Ciências da Saúde, Universidade Federal do Rio Grande do Norte, Natal-RN, Brazil.
Clinical Pharmacy Unit, Onofre Lopes University Hospital, Centro de Ciências da Saúde, Universidade Federal do Rio Grande do Norte, Natal-RN, Brazil.
Transplantation. 2024 Jan 1;108(1):284-293. doi: 10.1097/TP.0000000000004758. Epub 2023 Aug 28.
After kidney transplant, nonadherence to immunosuppressive therapy is the main cause of impaired kidney function and graft loss. The objective of this study was the development and internal validation of a clinical questionnaire for assessing the predisposition to adherence to immunosuppressive therapy in kidney pretransplant patients.
Multicenter prospective study conducted in 7 kidney hemodialysis and 6 kidney transplant centers of 3 Brazilian state capitals. Kidney transplant candidate patients of both sexes and >18-y-old were included. Retransplanted patients were excluded. A 72-item pilot version of the questionnaire, created through literature review complemented with a focus group of 8 kidney pretransplant patients, was administered to 541 kidney transplant candidate patients. Factor analysis with varimax rotation was used for questionnaire development. Internal validity evaluation used Cronbach's alpha and test-retest reliability. Construct validity was assessed by differentiation by known groups.
The final questionnaire, named Kidney AlloTransplant Immunosuppressive Therapy Adherence (KATITA) Questionnaire, consisting of 25 items in 3 dimensions, presented good internal consistency reliability (Cronbach's alpha 0.81). The 3 dimensions and respective Cronbach's alpha were "Carelessness" (14 items, 0.81), "Skepticism" (6 items, 0.57), and "Concern" (5 items, 0.62). The interdimension correlation matrix showed low correlation coefficients (<0.35). Test-retest reliability, evaluated with 154 patients, showed an intraclass correlation coefficient of 0.62 (moderate agreement). The scale showed construct validity.
The KATITA-25 questionnaire is the first psychometric instrument for evaluation of predisposition to nonadherence to immunosuppressive medication in candidate patients for kidney transplant in the pretransplant setting.
肾移植后，不坚持免疫抑制治疗是肾功能受损和移植肾丢失的主要原因。本研究的目的是开发并进行内部验证一种临床问卷，以评估肾移植术前患者坚持免疫抑制治疗的倾向。
在巴西3个州首府的7个肾脏血液透析中心和6个肾脏移植中心进行多中心前瞻性研究。纳入年龄大于18岁的男女肾移植候选患者。排除再次移植患者。通过文献综述并辅以8名肾移植术前患者的焦点小组创建的72项问卷试行版，应用于541名肾移植候选患者。采用方差最大化旋转的因子分析进行问卷开发。内部效度评估采用Cronbach's α系数和重测信度。通过已知分组的差异评估结构效度。
最终问卷名为肾移植免疫抑制治疗依从性（KATITA）问卷，由3个维度的25个项目组成，具有良好的内部一致性信度（Cronbach's α系数为0.81）。3个维度及其各自的Cronbach's α系数分别为“粗心大意”（14个项目，0.81）、“怀疑态度”（6个项目，0.57）和“担忧”（5个项目，0.62）。维度间相关矩阵显示相关系数较低（<0.35）。对154名患者进行重测信度评估，组内相关系数为0.62（中等一致性）。该量表显示出结构效度。
KATITA - 25问卷是首个用于评估肾移植术前候选患者不坚持免疫抑制药物治疗倾向的心理测量工具。
