Prevalence, consequences, and determinants of nonadherence in adult renal transplant patients: a literature review.
This literature review summarizes the evidence on the prevalence, determinants, clinical and economic consequences of nonadherence with immunosuppressive drugs in renal transplant patients. A literature search yielded 38 articles measuring nonadherence by self-report, collateral report, assay, refill prescriptions or electronic monitoring. The weighted mean prevalence of self-reported nonadherence was 28%. Nonadherence is associated with poor clinical outcomes, contributing to 20% of late acute rejection episodes and 16% of the graft losses (weighted means). In addition, nonadherence results in lower lifetime costs because of shorter survival, yet also in a lower number of quality adjusted life years. Consistent determinants of nonadherence were younger age, social isolation, and cognitions (e.g. low self-efficacy, certain health beliefs). Determinants concerning the health care system/team seem to be under-investigated. Because the evidence summarized in this review is based on older immunosuppressive regimens, further research should focus on prevalence, determinants and consequences of nonadherence with newer immunosuppressive regimens.
Denhaerynck
Kris
K
Institute of Nursing Science, University of Basel, Bernoullistrasse 28, CH-4056 Basel, Switzerland.
Dobbels
Fabienne
F
Cleemput
Irina
I
Desmyttere
Ariane
A
Schäfer-Keller
Petra
P
Schaub
Stefan
S
De Geest
Sabina
S
D000328:Adult; D005260:Female; D006084:Graft Rejection; D006801:Humans; D007166:Immunosuppressive Agents / Q000494:pharmacology / Q000627:therapeutic use; D016030:Kidney Transplantation / Q000191:economics / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D016896:Treatment Outcome; D016312:Treatment Refusal
D007166:Immunosuppressive Agents