Factors relevant to medication non-adherence in kidney transplant: a systematic review.
Belaiche S, Decaudin B, et al.International Journal of Clinical Pharmacy 2017; 03: 03.
Aims
To conduct a systematic review to identify factors most relevant to medication non-adherence in kidney transplant recipients.
Interventions
The databases Medline, Web of science and the Cochrane library were searched from January 2009 to December 2014 for primary research studies on factors related to adherence or non-adherence in adult kidney recipients at any time after transplant, regardless of study duration or design. Searches were restricted to include only original English-language studies on subjects aged ≥18 years.
Participants
37 studies were included in the analysis.
Outcomes
The primary measured outcome was non-adherence. Other measured outcomes were factors relating to non-adherence such as socio-demographic status, psychological disorders, quality of life, and disease and drug related factors.
Follow-up
Not described
CET Conclusions
This systematic review aimed to identify the factors most relevant to medication non-adherence in kidney transplant recipients. The authors identified several broad areas that are contributory to non-adherence: male sex, age <50 years, low social support, low education, unemployment, >3 months after transplantation, living donor, >6 comorbidities, >5 drugs, >2 intakes per day, negative beliefs or behaviour, depression and anxiety. As these were identified from different papers, the covariance or interaction of these factors could not be assessed by the authors. In some included studies, the rates of non-adherence were as high as 96%! The most common methods of assessing non-adherence were electronic monitoring, mixed methods, and CNI trough levels. The authors identified barriers to adherence and advocate multiple methods to monitor and predict adherence.
Quality notes
Quality assessment not appropriate
Trial registration
PROSPERO ID - CRD42015007393