Evaluation of non-adherence in patients undergoing dialysis and kidney transplantation: United States transplantation practice patterns survey.
BACKGROUND
We performed a survey of United States transplantation centers to evaluate practice patterns in the assessment of nonadherence before and after kidney transplantation.


METHODS
An electronically administered, anonymous survey was sent to 181 United Network for Organ Sharing (UNOS) approved transplantation centers in 2012.


RESULTS
Seventy-nine centers completed our survey. Of them, 51.3% had a protocol to evaluate medication/dialysis adherence before the listing; most common (36.4%) was the Simplified Medication Adherence Questionnaire. As an alternative to a questionnaire, the most common measure of nonadherence was the number of missed hemodialysis sessions (77.0%). The most common reason for poor adherence to dialysis regimens was difficulty with transportation (81.3%). Also, 94.4% noted the lack of a questionnaire to evaluate adherence to medications but relied on drug levels (73.4%) and self report. Only 12.9% used a questionnaire for the measurement of quality of life (Karnofsky performance scale). Of the participating centers, 27.1% used a formal cognitive testing for potential living donors. A social worker was used by most centers for nonadherent patients. Respondents indicated that patients (in the pretransplantation state) were more compliant with dialysis than with medication regimens. Finally, 37.7% of respondents noted graft failure due to medication nonadherence in 15% to 29% of their patients.


CONCLUSIONS
There was a significant variability in the methods of screening for nonadherence while the patient was on dialysis, during pretransplantation work up, and during post-transplantation follow-up examinations. We recommend that there should be a standardized technique to evaluate nonadherence to facilitate focused clinical trials to improve adherence.
Department of Medicine, State University of New York Downstate School of Medicine, Brooklyn, NY.
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Brar
Naval Medical Center San Diego, San Diego, CA.
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Babakhani
Department of Medicine, State University of New York Downstate School of Medicine, Brooklyn, NY.
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Salifu
Walter Reed National Military Medical Center, Army-Navy Transplant Service, Bethesda, MD; Uniformed Services University of the Health Sciences, Department of Surgery, Bethesda, MD. Electronic address: jindalr@msn.com.
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Jindal
D006801:Humans; D016030:Kidney Transplantation; D010349:Patient Compliance; D006435:Renal Dialysis; D014481:United States