Torres-Gutiérrez Manuel, Burgos-Camacho Viviana, Caamaño-Jaraba Jessica Paola, Lozano-Suárez Nicolás, García-López Andrea, Girón-Luque Fernando
Department of Mental Health, Colombiana de Trasplantes, Bogotá, Colombia.
Department of Transplant Research, Colombiana de Trasplantes, Bogotá, Colombia.
Patient Prefer Adherence. 2023 Sep 6;17:2201-2213. doi: 10.2147/PPA.S419324. eCollection 2023.
In renal transplant recipients, compliance with medical therapy is vital. Non-adherence is considered a risk factor for worst outcomes in kidney recipients, with attributed outcomes of 64% for graft loss and 80% for late acute rejection. Most literature defines adherence as self-based immunosuppression compliance but does not consider other relevant factors such as consult and procedure compliance. Therefore, this study aims to describe adherence prevalence in kidney transplant recipients and the factors related to non-adherence.
This cross-sectional study included 1030 renal transplant patients followed by Colombiana de Trasplantes between January 2019 and July 2021. Sociodemographic and clinical variables were obtained based on clinical records. The mental-health group diagnosed holistic adherence in a semi-structured interview. The diagnosis considered medication intake failure, frequency and number of failures to medical controls or other procedures, suspicious non-adherence behaviors, and serum levels of immunosuppressants. A bivariate followed a descriptive analysis, and a forward logistic regression was performed for non-adherence.
Patients had a median of 47 years, and 58.1% were male. Non-adherence was presented in 30.7% of patients. The non-adherence patients were younger, with a higher prevalence of males, single, divided transplant care, had a longer time after transplantation, psychopathological diagnosis, and more reinforcement education by only nursing. Older age and multidisciplinary reinforcement education were protective factors. On the other hand, poor social support, psychopathology diagnosis, and longer time after transplant presented as non-adherence risk factors.
Holistic non-adherence was diagnosed in approximately one-third of renal transplant recipients. Its definition included more than just medication non-compliance and could identify more non-adherent patients. Notably, there is a need to consider the related factors in the health follow-up and encourage future research in modifiable factor interventions aiming to increase adherence and achieve better outcomes for renal transplant patients.
在肾移植受者中，坚持药物治疗至关重要。不依从被认为是肾移植受者出现最差结局的一个危险因素，据估计，移植肾丢失的归因结局为64%，晚期急性排斥反应的归因结局为80%。大多数文献将依从性定义为基于自我的免疫抑制治疗依从性，但未考虑其他相关因素，如咨询和程序依从性。因此，本研究旨在描述肾移植受者的依从性患病率以及与不依从相关的因素。
这项横断面研究纳入了2019年1月至2021年7月期间由哥伦比亚移植协会随访的1030例肾移植患者。根据临床记录获取社会人口统计学和临床变量。心理健康小组在半结构化访谈中诊断整体依从性。该诊断考虑了药物摄入失败、医疗检查或其他程序失败的频率和次数、可疑的不依从行为以及免疫抑制剂的血清水平。进行了双变量描述性分析，并对不依从进行了向前逻辑回归分析。
患者的年龄中位数为47岁，58.1%为男性。30.7%的患者存在不依从情况。不依从的患者更年轻，男性患病率更高，单身，接受分散的移植护理，移植后时间更长，有精神病理学诊断，且仅接受护理的强化教育更多。年龄较大和多学科强化教育是保护因素。另一方面，社会支持差、精神病理学诊断和移植后时间较长是不依从的危险因素。
约三分之一的肾移植受者被诊断为整体不依从。其定义不仅包括药物不依从，还能识别出更多不依从的患者。值得注意的是，在健康随访中需要考虑相关因素，并鼓励未来针对可改变因素干预措施的研究，以提高依从性并为肾移植患者实现更好的结局。
