title: Prevalence and correlates of medication non-adherence among kidney transplant recipients more than 6 months post-transplant: a cross-sectional study.
abstract: BACKGROUND
  Among kidney transplant recipients, non-adherence with immunosuppressive medications frequently precedes allograft loss. We sought to determine the prevalence and correlates of medication non-adherence among kidney transplant recipients.
  
  
  METHODS
  We performed a single-center, cross-sectional study of kidney transplant recipients who were at least 6 months post-transplant. We measured self-reported adherence using the Immunosuppressive Therapy Adherence Scale (ITAS, which is scored from 0 to 12, where higher scores indicate increased adherence) and barriers to adherence using the Immunosuppressive Therapy Barriers Scale (ITBS). We also used validated scales to measure perceived stress, health literacy, anxiety, depression, and interpersonal support.
  
  
  RESULTS
  The 252 patients included in the study were 59.9% male, 27.0% Black, and at a median of 2.9 years post-transplant (interquartile range [IQR] 1.4-5.8). On the ITAS, 59.1% scored a perfect 12, 26.6% scored 10-11, and 14.3% scored 0-9. In univariate models, non-adherence (defined as ITAS score ≤9) was significantly associated with increased scores on scales for perceived stress (OR 1.12, 95% CI 1.01-1.25) and depression (OR 1.14, 95% CI 1.02-1.28), and with more self-reported barriers to adherence on the ITBS (OR 1.15, 95% CI 1.08-1.22). After adjusting for sociodemographic factors, stress and depression were not associated with non-adherence. Higher scores on the ITBS (corresponding to more self-described barriers to adherence) were associated with lower scores on the ITAS (P < 0.001). Several individual barriers were associated with non-adherence.
  
  
  CONCLUSIONS
  Among prevalent kidney transplant recipients, a minority is non-adherent. Practical barriers to adherence may serve as promising targets for future interventions.
authors.affiliation: Saint Barnabas Medical Center, Renal & Pancreas Transplant Division, 94 Old Short Hills Road, East Wing, Suite 305, Livingston, New Jersey 07039, USA. fweng@barnabashealth.org.
authors.forename: Francis L
authors.initials: FL
authors.lastname: Weng
authors.forename: Sheenu
authors.initials: S
authors.lastname: Chandwani
authors.forename: Karen M
authors.initials: KM
authors.lastname: Kurtyka
authors.forename: Christopher
authors.initials: C
authors.lastname: Zacker
authors.forename: Marie A
authors.initials: MA
authors.lastname: Chisholm-Burns
authors.forename: Kitaw
authors.initials: K
authors.lastname: Demissie
mesh_terms: D017677:Age Distribution; D015984:Causality; D015897:Comorbidity; D003430:Cross-Sectional Studies; D004522:Educational Status; D005260:Female; D006084:Graft Rejection / Q000453:epidemiology* / Q000517:prevention & control*; D006085:Graft Survival / Q000187:drug effects; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007676:Kidney Failure, Chronic / Q000453:epidemiology* / Q000601:surgery*; D016030:Kidney Transplantation / Q000706:statistics & numerical data*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009515:New Jersey / Q000453:epidemiology; D015995:Prevalence; D012307:Risk Factors; D017678:Sex Distribution; D012923:Social Class; D013223:Statistics as Topic; D016896:Treatment Outcome; D016903:Drug Monitoring
chemical_list: D007166:Immunosuppressive Agents