title: A single daily dose enhances the adherence to immunosuppressive treatment in kidney transplant recipients: a cross-sectional study.
abstract: BACKGROUND
  Nonadherence to treatment regimens for immunosuppressive agents is one of the major risk factors for allograft failure in kidney transplant recipients. The aim of this study was to estimate the relative effect of daily dosing on treatment adherence, not to identify how patients are non-adherent, in long-term kidney transplant recipients.
  
  
  METHODS
  In January 2009, a cross-sectional, anonymous, and voluntary questionnaire survey was given to kidney transplant recipients who regularly visited Inoue Hospital. A self-reporting questionnaire underestimates nonadherence, but we reasoned that the effect of the dosing regimen should be estimated with relative accuracy by using the generalized ordered logit/partial proportional hazard odds model given that the distribution patterns in the degree of nonadherence have been shown to be similar with other measures.
  
  
  RESULTS
  Of 336 eligible patients, 312 (92.9 %) participated in this study. Two hundred seventy-four patients (87.8 %) were more than 3 years post-transplant. Univariate analysis revealed that a single daily dose was significantly associated with better adherence. After controlling for age, sex, time since transplantation, and the number of prescribed drugs, the effect of a single daily dose still remained significant [odds ratio, 0.40 (95 % confidence interval, 0.19-0.81); p = 0.011]. Several sensitivity analyses yielded similar results.
  
  
  CONCLUSIONS
  To our knowledge, this is the first report that, in long-term kidney transplant recipients, a single daily regimen-one of few modifiable factors-might improve treatment adherence and allograft survival.
authors.affiliation: Department of Geriatric Medicine and Nephrology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.
authors.forename: Yoshitsugu
authors.initials: Y
authors.lastname: Obi
authors.forename: Naotsugu
authors.initials: N
authors.lastname: Ichimaru
authors.forename: Taigo
authors.initials: T
authors.lastname: Kato
authors.forename: Jun-Ya
authors.initials: JY
authors.lastname: Kaimori
authors.forename: Masayoshi
authors.initials: M
authors.lastname: Okumi
authors.forename: Koji
authors.initials: K
authors.lastname: Yazawa
authors.forename: Hiromi
authors.initials: H
authors.lastname: Rakugi
authors.forename: Norio
authors.initials: N
authors.lastname: Nonomura
authors.forename: Yoshitaka
authors.initials: Y
authors.lastname: Isaka
authors.forename: Shiro
authors.initials: S
authors.lastname: Takahara
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D016030:Kidney Transplantation / Q000276:immunology*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009790:Occupations; D016017:Odds Ratio; D010349:Patient Compliance / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D014019:Tissue Donors; D055815:Young Adult
chemical_list: D007166:Immunosuppressive Agents