Medication non-adherence after kidney transplantation: A critical appraisal and systematic review

SummaryMedication non-adherence is one of the most important causes for shortened graft survival subsequently leading to a reduction in kidney graft survival results. Our aim was to provide an overview of its prevalence, risk factors, diagnostic methods and interventions to improve adherence in kidn...

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Published in:Transplantation reviews (Philadelphia, Pa.) Pa.), 2020-01, Vol.34 (1), p.100511-100511, Article 100511
Main Authors: Gokoel, Sumit R.M, Gombert-Handoko, Kim B, Zwart, Tom C, van der Boog, Paul J.M, Moes, Dirk Jan A.R, de Fijter, Johan W
Format: Article
Language:English
Subjects:
Graft Rejection - drug therapy
Humans
Immunosuppressive Agents - therapeutic use
Kidney Transplantation
Medication Adherence - statistics & numerical data
Prevalence
Risk Factors
Surgery
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Summary:SummaryMedication non-adherence is one of the most important causes for shortened graft survival subsequently leading to a reduction in kidney graft survival results. Our aim was to provide an overview of its prevalence, risk factors, diagnostic methods and interventions to improve adherence in kidney transplant recipients. Therefore, we systematically searched the databases PubMed, COCHRANE Library, Web of Science and EMBASE for studies addressing “medication adherence”, “compliance”, “adherence”, “kidney transplantation” and “life style factors”. We identified 96 studies that satisfied our inclusion criteria. A problematic lack of a uniformly accepted definition for non-adherence was found, consequently leading to a wide range in non-adherence prevalence (36–55%). Using one uniformly accepted non-adherence definition should therefore be encouraged. A wide range in diagnostic methods makes it difficult to accurately detect non-adherence. Heterogeneous results of intervention studies make it difficult to select the best adherence enhancing method, challenging the battle against medication non-adherence. Literature suggests a combination of personalized interventions, based on patient-specific non-adherent behavior, to be most successful in improvement of adherence. High quality diagnostic methods and multidisciplinary, personalized interventions with focus on relevant clinical outcome are essential in overcoming medication non-adherence in kidney transplant recipients.
ISSN:0955-470X
1557-9816
DOI:10.1016/j.trre.2019.100511