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By Isabel Acosta-Ochoa Nephrology senior staff. Valladolid. Spain
Helady Sanders-Pinheiro, Fernando Antonio Basile Colugnati, Elisa Oliveira Marsicano, Sabina De Geest, José Osmar Pestana Medina
BACKGROUND: Non-adherence to immunosuppressive therapy is a prevalent risk factor for poor clinical and after kidney transplantation (KT), and has contributed to the lack of improvement in long-term graft survival over the past decade. Understanding the multilevel correlates and risk factors of non-adherence is crucial to determine the optimal level for planning interventions, namely at the patient, health care provider, KT centre, and health care system level. Brazil, having the largest public transplantation program in the world and with regional differences regarding access to health services and service implementation, is in a unique position to study this multilevel approach...
February 20, 2018: BMC Nephrology
Nora Drick, Benjamin Seeliger, Jan Fuge, Igor Tudorache, Mark Greer, Tobias Welte, Axel Haverich, Jens Gottlieb
BACKGROUND: Non-adherence to immunosuppressive treatment following solid organ transplantation is common and often associated with poorer outcomes. Non-adherence is difficult to assess and barriers to adherence in lung transplant (LTx) recipients remain to be elucidated. METHODS: A single center cross-sectional observational study of all LTx recipients attending our department between 07/2013 - 05/2014 was performed. Non-adherence was assessed using patient self-reporting, including Basel Assessment of Adherence with Immunosuppressive Medication Scale (BAASIS) along with health care worker (HCW) judgement and reasons for non-adherence by the Immunosuppressive Therapy Barriers Scale...
January 29, 2018: Clinical Transplantation
Maria das Graças Mariano Nunes de Paiva, Jéssica Dantas de Sá Tinôco, Maria Isabel da Conceição Dias Fernandes, Juliane Rangel Dantas, Isadora Lorenna Alves Nogueira, Ana Beatriz de Almeida Medeiros, Marcos Venícios de Oliveira Lopes, Ana Luisa Brandão de Carvalho Lira
This study analyzed the accuracy of clinical indicators of ineffective health management in hemodialysis patients. A diagnostic accuracy study was performed in 200 chronic kidney disease patients undergoing hemodialysis during the first half of 2015. Measures of sensitivity and specificity were calculated using latent class analysis. Ineffective health management was present in 66.28% of patients. Accurate clinical indicators included expressed nonadherence to treatment, daily life choices ineffective to achieve health goals, expression of difficulty with prescribed regimens, inappropriate use of medicines, lack of expression of willingness to control the disease, irregular attendance of dialysis sessions, and infection...
January 1, 2018: Clinical Nursing Research
Amelia R Cossart, Christine E Staatz, Scott B Campbell, Nicole M Isbel, W Neil Cottrell
BACKGROUND: Immunosuppressant medication non-adherence can result in allograft rejection and loss. The aim of this study was to investigate the prevalence of non-adherence and barriers to adherence with immunosuppressant medications, in an adult renal transplant cohort. METHODS: Kidney transplant recipients completed a self-report survey consisting of five validated questionnaires (Basel Assessment of Adherence Immunosuppression Scale (BAASIS), Beliefs about Medicines Questionnaire, Immunosuppressant Therapy Barrier Scale, Brief-Illness Perception Questionnaire, and Multidimensional Health Locus of Control Scale), and provided sociodemographic information...
December 26, 2017: Nephrology
Fergus William Gardiner, Ezekiel Uba Nwose, Phillip Taderera Bwititi, Judith Crockett, Lexin Wang
AIMS: To determine the extent to which targets for blood pressure (BP) (<140.90 mmHg) and random blood glucose level (BGL) (<7.7 mmol/L) control in patients with chronic kidney disease (CKD) are achieved; and the extent clinical inertia affects BP and glucose control in CKD and diabetes mellitus (DM). METHODS: Data was collected from the 1st January 2015 until 31st December 2015 on key patient pathology, admission reason, final discharge diagnosis, and information concerning clinical guideline adherence...
December 16, 2017: Diabetes & Metabolic Syndrome
Stacy Crown, Janet A Vogel, Christina Hurlock-Chorostecki
Patients receiving hemodialysis are challenged with restricting their fluid intake to ensure appropriate interdialytic weight gains. While nurses endeavor to promote selfcare, the ability to manage fluid gain rests on the patient's understanding and decision to limit fluid intake. A mixed-methods pilot study was undertaken to determine if motivational interviewing, a patient-centered, conversational, and collaborative approach to stimulating behavior change and resolving ambivalence, enhances self-care fluid management...
January 2017: Nephrology Nursing Journal: Journal of the American Nephrology Nurses' Association
Jing Wang, Peng Yue, Jing Huang, Xiaodong Xie, Yunhua Ling, Li Jia, Yunjin Xiong, Fang Sun
BACKGROUND: Dialysis is imperative for patients with end-stage renal disease (ESRD); however, compliance ensures its efficacy. Nursing intervention has been considered to improve compliance. This meta-analysis is aimed at exploring the effects of nursing intervention on dialysis compliance. METHODS: A search was performed in the PubMed, Cochrane, and Embase databases for relevant original research articles. Studies were included or excluded based on the simultaneous consideration of quality as ranked by Jadad score and the compliance with predefined selection criteria...
December 12, 2017: Blood Purification
Konstadina Griva, Mooppil Nandakumar, Jo-An H Ng, Kevin F Y Lam, Hayley McBain, Stanton P Newman
BACKGROUND: Poor adherence to treatment is common in hemodialysis patients. However, effective interventions for adherence in this population are lacking. Small studies of behavioral interventions have yielded improvements, but clinical effectiveness and long-term effects are unclear. STUDY DESIGN: Multicenter parallel (1:1) design, blinded cluster-randomized controlled trial. SETTING & PARTICIPANTS: Patients undergoing maintenance hemodialysis enrolled in 14 dialysis centers...
March 2018: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
Lukas J Lehner, Petra Reinke, Jan Hörstrup, Thomas Rath, Barbara Suwelack, Bernhard K Krämer, Klemens Budde, Bernhard Banas
This study assessed adherence to prolonged-release tacrolimus (PR-T)-based immunosuppression during routine maintenance of renal transplant recipients in Germany. Patients had received PR-T for ≥1 month at inclusion. Data were collected during four visits (V): baseline (V1), 6 (V2), 12 (V3) and 18 (V4) months. Composite primary endpoint: non-adherence at V4, defined as self-reported non-adherence on the Basel Assessment of Adherence with Immunosuppressive Medication Scale (BAASIS©), investigator-rated non-adherence, and/or V4 tacrolimus trough level outside a pre-defined range...
October 20, 2017: Clinical Transplantation
Kate Navaratnam, Zarko Alfirevic, Munir Pirmohamed, Ana Alfirevic
Low-dose aspirin (LDA) is advocated for women at high-risk of pre-eclampsia, providing a modest, 10%, reduction in risk. Cardiology meta-analyses demonstrate 18% reduction in serious vascular events with LDA. Non-responsiveness to aspirin (sometimes termed aspirin resistance) and variable clinical effectiveness are often attributed to suboptimal adherence. The aim of this review was to identify the scope of adherence assessments in RCTs evaluating aspirin effectiveness in cardiology and obstetrics and discuss the quality of information provided by current methods...
December 2017: European Journal of Obstetrics, Gynecology, and Reproductive Biology
Mohsen Bazargan, James Smith, Hamed Yazdanshenas, Masoud Movassaghi, David Martins, Gail Orum
BACKGROUND: Despite concerns about racial differences on adherence to prescribed medication rigimens among older adults, current information about nonadherence among underserved elderly African Americans with co-morbidities is limited. This study examines the association between adherence to drug regimens and an array of medication-related factors, including polypharmacy, medication regimen complexity, use of Potentially Inappropriate Medications (PIM), and knowledge about the therapeutic purpose and instructions of medication use...
July 25, 2017: BMC Geriatrics
Wen-Ching Tran, David Huynh, Tea Chan, Catherine A Chesla, Meyeon Park
BACKGROUND: Autosomal dominant polycystic kidney disease (PKD) is the most common genetic renal disease and the fourth leading cause of end-stage renal disease in the United States. Although there is no cure for PKD, several treatments are considered to be beneficial, including blood pressure control, exercise, low-salt diet, and high volume water intake. However, levels of understanding of the importance of these treatments and adherence to these recommendations vary among patients. This study explores illness perception models of patients with PKD to reveal barriers in adherence to prescribed therapies; satisfaction with medical care; and sources of medical information...
July 5, 2017: BMC Nephrology
A Som, J Groenendyk, T An, K Patel, R Peters, G Polites, W R Ross
Comorbidities and socioeconomic barriers often limit patient adherence and self-management with hemodialysis. Missed sessions, often associated with communication barriers, can result in emergency dialysis and avoidable hospitalizations. This proof of concept study explored using a novel digital-messaging platform, EpxDialysis, to improve patient-to-dialysis center communication via widely available text messaging and telephone technology. A randomized controlled trial was conducted through Washington University-affiliated hemodialysis centers involving ESRD patients with poor attendance, defined as missing 2-6 sessions over the preceding 12 weeks...
June 23, 2017: Scientific Reports
Anita Slomski
No abstract text is available yet for this article.
June 27, 2017: JAMA: the Journal of the American Medical Association
Fanny Lepeytre, Héloise Cardinal, Lorraine Fradette, Jacobien Verhave, Marc Dorais, Jacques LeLorier, Vincent Pichette, François Madore
Background: The aim of this study was to assess the impact of follow-up in renal protection clinics on the prescription of and adherence to cardioprotective drugs in patients with chronic kidney disease (CKD). Methods: We studied stage 4 and 5 CKD patients who initiated follow-up in three renal protection clinics. The prescription pattern of antihypertensive agents (AHA) and lipid-lowering agents (LLAs) was measured as the percentage of patients who are prescribed the agents of interest at a given time. Adherence to drug therapy was defined as the percentage of days, during a pre-defined observation period, in which patients have an on-hand supply of their prescribed medications...
June 2017: Clinical Kidney Journal
Thomas E Nevins, Peter W Nickerson, Mary Amanda Dew
Alloimmunity remains a barrier to long-term graft survival that necessitates lifelong immunosuppressive therapy after renal transplant. Medication nonadherence has been increasingly recognized as a major impediment to achieving effective immunosuppression. Electronic medication monitoring further reveals that nonadherence manifests early after transplant, although the effect is delayed. The etiology of nonadherence is multifactorial, with the strongest risk factors including past nonadherence and being an adolescent or young adult...
August 2017: Journal of the American Society of Nephrology: JASN
Kathryn S Gray, Dena E Cohen, Steven M Brunelli
OBJECTIVE: The aim of this study was to determine the rate of missed treatments among hemodialysis (HD) patients, and the association between treatment nonadherence and clinical outcomes. DATA SOURCE: The data used in this study were based on electronic medical records and Medicare claims. STUDY DESIGN: This is a retrospective, observational study. PRINCIPAL FINDINGS: HD patients miss 9.9% of all treatments. Approximately half of the missed treatments are due to observable medical events, predominantly hospitalizations, while half result from nonadherence ("absence")...
2017: ClinicoEconomics and Outcomes Research: CEOR
Karam Sh Naalweh, Mohammad A Barakat, Moutaz W Sweileh, Samah W Al-Jabi, Waleed M Sweileh, Sa'ed H Zyoud
BACKGROUND: Adherence to diet recommendations, fluid restriction, prescribed medications, and attendance at hemodialysis (HD) sessions are essential for optimal and effective treatment of patients with end-stage renal disease. No data regarding this issue are available from Palestine. Therefore, this study was carried out to assess adherence to diet, fluid restriction, medications, and HD sessions. METHODS: A cross-sectional study of HD patients at An-Najah National University Hospital was carried out during summer, 2016...
May 30, 2017: BMC Nephrology
Saurav Ghimire, Ronald L Castelino, Matthew D Jose, Syed Tabish R Zaidi
BACKGROUND: End-stage kidney disease patients undergoing haemodialysis are prescribed with multiple complex regimens and are predisposed to high risk of medication nonadherence. The aims of this study were to explore factors associated with medication adherence, and, to examine the differential perspectives on medication-taking behaviour shown by adherent and nonadherent haemodialysis patients. METHODS: A qualitative exploratory design was used. One-on-one semi-structured interviews were conducted with 30 haemodialysis patients at the outpatient dialysis facility in Hobart, Australia...
May 22, 2017: BMC Nephrology
M Dolores Arenas Jiménez, Eduardo Parra Moncasi, Fernando Álvarez-Ude Cotera
PURPOSE: Phosphate binders (PB) have to be taken with food, their interference with an individual's lifestyle and social habits influences treatment adherence. Several PBs are available, and patient preferences should not be ignored when prescribing. The purpose was to know the extent of intentional and unintentional nonadherence to PB in hemodialysis (HD) patients, and to evaluate the long-term results (adherence, serum phosphate levels, and cost) of a strategy of prescription of PB that takes into account patient preferences...
April 25, 2017: Clinical Nephrology
2017-04-27 05:58:20
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