Transplant recipients show greater overall ‘adherence’ vs patients on dialysis
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Compared with patients on hemodialysis, kidney transplant recipients were more likely to follow health care provider recommendations on pharmacotherapy and lifestyle behaviors, according to this study.
“Adherence, defined as ‘the extent to which the patient’s behavior matches the agreed-upon health care provider’s recommendations,’ is an essential determinant of a favorable treatment outcome,” Maja Nowicka, MD, of the department of internal medicine and transplant nephrology at the Medical University of Lodz in Poland, and colleagues wrote. “However, the World Health Organization reports that even in developed countries only 50% of the chronically ill present satisfactory adherence. The consequences of nonadherence have not only an individual but also a socioeconomic impact, since they decrease general health care efficacy.”
To assess the extent to which patients with kidney failure demonstrated adherence, the researchers administered questionnaires to 86 patients on hemodialysis and 124 kidney transplant recipients. The questionnaires determined patients’ use of over-the-counter medications and dietary supplements; adherence to pharmacotherapy; diet (eg, limiting salt and calorie intake); use of alcohol, coffee and tobacco; volume of fluid consumed daily; and frequency of at-home blood pressure and glucose measurements.
Researchers found both patient groups reported using OTC medications without medical consultation (this was more frequent in patients on dialysis: 42.1% vs. 39.4% of transplant recipients), with patients on dialysis also more likely to use dietary supplements (43.9% vs. 31.1%). Failing to notify the doctor about use of these medications was more prevalent for patients on dialysis (52.2% vs. 21.4%).
“Both [kidney transplant recipients] KTx and [hemodialysis] HD patients alike are prone to using [dietary supplements] DS and OTC medications without professional recommendation,” the researchers wrote of the findings. “These substances are heavily advertised in Polish mass media — in 2015, they formed the most advertised sector of products and accounted for a quarter of all TV commercials, vitamins and so-called ‘immune boosters’ being the most popular topic ... What is unsettling, a great number of our patients, both HD and KTx neglected to inform their physician about ingesting OTC medications and DS.”
Further results showed more patients dialysis skipped medication doses (33.6% vs. 9.7%), drank alcohol (40.2% vs. 20.5%) and smoked (22.4% vs. 10.5%), while more transplant recipients limited their caloric (66.4% vs. 46.7%) and salt intake (84.9% vs. 73.8%).
Nowicka and colleagues found the results of the study to be “surprising,” because patients receiving hemodialysis have more frequent interactions with doctors (around three times per week), while transplant recipients attend follow-up visits only once every 3 to 4 months.
“Hemodialyzed patients exhibit worse adherence to pharmacotherapy and lifestyle recommendations than kidney graft recipients which, considering the long duration of the therapy, highlights the need for constant re-education and motivation,” the researchers concluded. “ ... Areas of non-adherence differ between patients and the results of this study will help to achieve better approaches to patient care and new research questions in the future.”
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