title: Symptom Experience Associated With Immunosuppressive Medications in Chinese Kidney Transplant Recipients.
abstract: OBJECTIVE
  Kidney transplant recipients require lifelong treatment with immunosuppressive medications to avoid graft rejection and graft loss. Symptoms experienced may influence recipients' perceived quality of life and medication adherence. The purpose of this study was to evaluate the symptom experience associated with immunosuppressive medications in adult kidney transplant recipients and to explore the association between the symptom experience and adherence to immunosuppressive medications.
  
  
  METHODS
  A cross-sectional design was used. The study was conducted in a general hospital in China from October 2013 to September 2014. A total of 231 recipients with a follow-up of at least 1 year after kidney transplantation were included.
  
  
  METHODS
  Symptom experience associated with immunosuppressive medications was measured by the 13-item Symptom Experience of Immunosuppressive-related Side Effects Scale. Self-reported adherence to immunosuppressive medications was assessed using the Adherence with Immunosuppressive Medication Scale. Ridit analysis was used to rank symptom distress items.
  
  
  RESULTS
  A proportion of 60.6% of recipients were male; the time after kidney transplantation was arbitrarily divided into a short-term cohort (1-4 years) and a long-term cohort (4-16 years) according to the median duration of follow-up (4 years). High blood pressure, hair loss, and tiredness were the three most distressing symptoms over all items of the whole sample. High blood pressure was the most distressing symptom for the 1- to 4-year cohort and the 4- to 16-year cohort. For men high blood pressure was the most distressing symptom, whereas for women hair loss was the most distressing symptom. Recipients in the 4- to 16-year cohort perceived a higher level of symptom distress compared with those in the 1- to 4-year cohort, especially in excess hair growth and difficulty sleeping. A negative relationship was found between symptom distress and adherence to immunosuppressive medications (r = -.541, p = .000).
  
  
  CONCLUSIONS
  Recipients in the 4- to 16-year cohort perceived a higher level of symptom distress compared with those in the 1- to 4-year cohort, especially in excess hair growth and difficulty sleeping. No significant difference was found between gender groups. Recipients who reported a higher level of symptom distress were more likely to be nonadherent.
  
  
  CONCLUSIONS
  Understanding symptom experience of immunosuppressive medications is of importance for healthcare providers to offer sophisticated education and develop strategies to improve quality of life and medication adherence during follow-up post-transplantation.
authors.affiliation: Master Degree Candidate, School of Nursing, Beijing University of Chinese Medicine, Beijing, China.
authors.forename: Sha
authors.initials: S
authors.lastname: Teng
authors.affiliation: Lecturer, School of Nursing, Beijing University of Chinese Medicine, Beijing, China.
authors.forename: Shuping
authors.initials: S
authors.lastname: Zhang
authors.affiliation: Master Degree Candidate, School of Nursing, Beijing University of Chinese Medicine, Beijing, China.
authors.forename: Wenxin
authors.initials: W
authors.lastname: Zhang
authors.affiliation: Master Degree Candidate, School of Nursing, Beijing University of Chinese Medicine, Beijing, China.
authors.forename: Xiaohong
authors.initials: X
authors.lastname: Lin
authors.affiliation: Master Degree Candidate, School of Nursing, Beijing University of Chinese Medicine, Beijing, China.
authors.forename: Yabin
authors.initials: Y
authors.lastname: Shang
authors.affiliation: Master Degree Candidate, School of Nursing, Beijing University of Chinese Medicine, Beijing, China.
authors.forename: Xiao
authors.initials: X
authors.lastname: Peng
authors.affiliation: Associate Professor, School of Nursing, Beijing University of Chinese Medicine, Beijing, China.
authors.forename: Hongxia
authors.initials: H
authors.lastname: Liu
mesh_terms: D000328:Adult; D000505:Alopecia / Q000139:chemically induced; D002681:China; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005221:Fatigue / Q000139:chemically induced; D005260:Female; D006801:Humans; D006973:Hypertension / Q000139:chemically induced; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D016030:Kidney Transplantation; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D011788:Quality of Life; D063189:Symptom Assessment / Q000379:methods; D013997:Time Factors; D055815:Young Adult
chemical_list: D007166:Immunosuppressive Agents
keywords: Immunosuppressive medications; kidney transplantation; medication adherence; symptom distress