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Non-adherence to Immunosuppressive Medications in Kidney Transplantation: Intent Vs. Forgetfulness and Clinical Markers of Medication Intake

  • Original Article
  • Published:
Annals of Behavioral Medicine

Abstract

Background

Although adherence to immunosupressive medication after transplantation is important to maximize good clinical outcomes it remains suboptimal and not well-understood. The purpose of this study was to examine intentional and unintentional non-adherence to immunosuppression medication in kidney transplant patients.

Methods

A cross-sectional sample of N = 218 patients [49.6 ± 12.3 years] recruited in London, UK (1999–2002) completed measures of medication beliefs, quality-of-life, depression, and transplantation-specific emotions. Adherence was measured with self-report and serial immunosuppressive assays.

Results

Intentional non-adherence was low (13.8 %) yet 62.4 % admitted unintentional non-adherence and 25.4 % had sub-target immunosuppressive levels. The risk of sub-target serum immunosuppressive levels was greater for patients admitting unintentional non-adherence (OR = 8.4; p = 0.004). Dialysis vintage, doubts about necessity, and lower worry about viability of graft explained R 2 = 16.1 to 36 % of self-report non-adherence. Depression was related only to intentional non-adherence.

Conclusions

Non-adherence is common in kidney transplantation. Efforts to increase adherence should be implemented by targeting necessity beliefs, monitoring depression, and promoting strategies to decrease forgetfulness.

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Acknowledgments

The data were gathered under grants from Onassis Heart Foundation to KG and the R.L. Weston Institute for Neurological Studies of the UCL Medical School, both of which are gratefully acknowledged. The authors would like to thank the clinic staff and respondents who contributed to this study and Dr Tonia Griva for her support.

Conflict of Interest Statement

The authors have no conflict of interest to disclose

Author information

Authors and Affiliations

  1. Department of Psychology, National University of Singapore, 9 Arts Link AS402/28, Singapore, Singapore

    Konstadina Griva Ph.D.

  2. Health Services Research Group, City University, College Building Room A224, St John Street, London, UK

    Konstadina Griva Ph.D. & Stanton P. Newman Ph.D.

  3. Department of Nephrology, University College and Royal Free Hospital, Pond Street, London, UK

    Andrew Davenport FDRC

  4. Unit of Behavioural Medicine, University College, Riding House Street, London, UK

    Michael Harrison FDRC

Authors
  1. Konstadina Griva Ph.D.
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  2. Andrew Davenport FDRC
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  3. Michael Harrison FDRC
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  4. Stanton P. Newman Ph.D.
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Correspondence to Stanton P. Newman Ph.D..

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Griva, K., Davenport, A., Harrison, M. et al. Non-adherence to Immunosuppressive Medications in Kidney Transplantation: Intent Vs. Forgetfulness and Clinical Markers of Medication Intake. ann. behav. med. 44, 85–93 (2012). https://doi.org/10.1007/s12160-012-9359-4

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  • DOI: https://doi.org/10.1007/s12160-012-9359-4

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