Nonadherence to immunosuppressives and treatment in kidney transplant: ADHERE BRAZIL Study

Abstract

Objective: To estimate the prevalence and variability of nonadherence to immunosuppressives and nonpharmacological treatment across kidney transplantation centers and two health access-disparate regions in Brazil.

Methods: In a cross-sectional design, a random multistage sample of 1,105 patients was included, based on center transplantation activity (low/moderate/high) and region (R1: North/Northeast/Mid-West; and R2: South/Southeast). Nonadherence to immunosuppressives (implementation phase) was assessed using the Basel Assessment of Adherence to Immunosuppressive Medications Scale (BAASIS)©. Self-report questionnaires assessed nonadherence to physical activity, smoking cessation, alcohol intake, and appointment keeping. We compared regions using the adjusted-χ2 or t-test.

Results: Most patients were men (58.5%), white (51.4%), and had a mean age of 47.5 (SD = 12.6) years. Regarding kidney transplantation centers, 75.9% were from R2 and 38.2% had low activity. The patients in R2 were older, white-majority, had more frequently steady partners, and received peritoneal dialysis. Nonadherence to immunosuppressives ranged from 11-65.2%; 44.5-90% to physical activity; 0-23.7% to appointment keeping; and 0-14% to smoking cessation. The total prevalence of nonadherence and by region (R1 versus R2) were: for immunosuppressives, 39.7% (44.9% versus 38.1%, p = 0.18); for smoking, 3.9% (1% versus 5%, p < 0.001); for physical activity, 69.1% (71% versus 69%, p = 0.48); for appointment keeping, 13% (12.7% versus 12%, p = 0.77); and for alcohol consumption, 0%.

Conclusion: Despite differences among centers and high variability, only the nonadherence to smoking cessation was higher in the region with greater access to kidney transplantation. We suppose that differences in healthcare access may have been overcome by other positive aspects of the post kidney transplantation treatment.

Figure 1. Flowchart of enrolment of KT patients. KT – kidney transplant.

Figure 2. Nonadherence to immunosuppressives (2A) and nonpharmacological treatment (2B: physical activity recommendations, 2C: scheduled appointments and, 2D: smoking cessation) in the total sample (dotted line), at each center (numbers in horizontal axis) and in health access-disparate regions. R1 = Northeast/North/Mid-West (green) and R2 = South/Southwest (orange). We compared the R1 versus R2 regions by adjusted Chi-square test.

Figure 3. Implementation nonadherence to immunosuppressives by BAASIS© scale dimensions [taking (2A), timing (2B), drug holidays (2C) and dose reduction (2D)] in total sample (dotted line), at each center (numbers in horizontal axis) and in health access-disparate regions. R1 = Northeast/North/Mid-West (green) and R2 = South/Southwest (orange). We compared the R1 versus R2 regions by adjusted Chi-square test.