title: Clinical consequences of non adherence to immunosuppressive medication in kidney transplant patients.
abstract: Little is known of the long-term clinical effects of non adherence on transplanted kidneys, especially regarding newer immunosuppressive regimens. In a study of 356 adult Swiss kidney transplant patients, non adherence was measured at inclusion by means of self-reporting, electronic monitoring, collateral reporting and blood assay. Long-term clinical outcomes regarding graft loss and creatinine levels were collected prospectively over a period of 5 years. A Cox proportional hazards model and mixed regression analysis were used, respectively, to examine the effects of non adherence on kidney survival and kidney function. The majority of patients (62%) were on immunosuppressive regimens that included mycophenolate mofetil, tacrolimus or sirolimus. No associations were found between non adherence and kidney graft survival or graft function. Notwithstanding weaknesses of this study, this negative result suggests that high adherence may protect patients against detrimental clinical outcomes, and/or that immunosuppressive regimens containing newer drugs allow wider non adherence margins than those based on previous generation medications such as cyclosporine, azathioprine and corticosteroids.
authors.affiliation: Institute of Nursing Science, University of Basel, Bernoullistrasse, Basel, Switzerland.
authors.forename: Kris
authors.initials: K
authors.lastname: Denhaerynck
authors.forename: Felix
authors.initials: F
authors.lastname: Burkhalter
authors.forename: Petra
authors.initials: P
authors.lastname: Schäfer-Keller
authors.forename: Jürg
authors.initials: J
authors.lastname: Steiger
authors.forename: Andeas
authors.initials: A
authors.lastname: Bock
authors.forename: Sabina
authors.initials: S
authors.lastname: De Geest
mesh_terms: D000328:Adult; D000368:Aged; D003404:Creatinine / Q000097:blood; D005260:Female; D006084:Graft Rejection / Q000517:prevention & control*; D006085:Graft Survival; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007677:Kidney Function Tests; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D011446:Prospective Studies
chemical_list: D007166:Immunosuppressive Agents; D003404:Creatinine