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. 2017;45(1):91-98.
doi: 10.1159/000453554. Epub 2016 Dec 2.

The Impact of Health Care Appointment Non-Adherence on Graft Outcomes in Kidney Transplantation

David J Taber  1 , James N Fleming, Cory E Fominaya, Mulugeta Gebregziabher, Kelly J Hunt, Titte R Srinivas, Prabhakar K Baliga, John W McGillicuddy, Leonard E Egede
Affiliations

The Impact of Health Care Appointment Non-Adherence on Graft Outcomes in Kidney Transplantation

David J Taber et al. Am J Nephrol. 2017.

Abstract

Background: Non-adherence to medication is a well-studied and known cause of late allograft loss, but it is difficult to measure and prospectively monitor. The aim of this study was to assess if appointment non-adherence was correlated with medication non-adherence and a predictor of graft outcomes.

Methods: This was a longitudinal cohort study that used the National United States Renal Data System and veterans affairs health records data with time-to-event analyses conducted to assess the impact on graft and patient survival.

Results: The number of transplants that were included in the analysis was 4,646 (3,656 with complete records); 14.6% of patients had an appointment no show rate of ≥12% (non-adherence). Appointment and medication non-adherence were highly correlated and both were significant independent predictors of outcomes. Those with appointment non-adherence had 1.5 times the risk of acute rejection (22.0 vs. 14.7%, p < 0.0001) and a 65% higher risk of graft loss (adjusted hazards ratio (aHR) 1.65, 95% CI 1.38-1.97, p < 0.0001). There was a significant interaction between appointment and medication non-adherence; those with appointment and medication non-adherence were at very high risk of graft loss (aHR 4.18, 95% CI 3.39-5.15, p < 0.0001), compared to those with only appointment non-adherence (aHR 1.39, 95% CI 0.97-2.01, p = 0.0766) or only medication non-adherence (aHR 2.44, 95% CI 2.11-2.81, p < 0.0001).

Conclusion: These results demonstrate that non-adherence to health care appointments is a significant and independent risk factor for graft loss.

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Conflict of interest statement

Research reported in this publication was supported by the National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health under Award Number K23DK099440.

Figures

Figure 1
Figure 1
Adjusted* graft survival estimates compared between appointment adherence cohorts
Figure 2
Figure 2
Adjusted* graft survival estimates compared between appointment and medication adherence cohorts
See this image and copyright information in PMC

Comment in

References

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