Does a High Pill Burden Impact Adherence in Renal Transplant Patients?

A new study found that pill burden was not considered a major factor in noncompliant renal transplant patients, which is likely to be multifactorial.

According to the study, published in the Indian Journal of Pharmacology, about 36% of graft losses are due to nonadherence in renal transplant patients.

Previous research suggested that nonadherence can be due to complex and lifelong immunosuppressive therapeutic regimens, as comorbidities add to this pill burden.

There were 120 patients included in this study who received a kidney transplant between July 2011 and December 2012. Researchers followed up with patients at 3-month intervals for 12 months.

Patients attended the nephrology posttransplant clinic of a tertiary care government and a private hospital.

Researchers used the 4-item Morisky Medication Adherence scale to screen for noncompliance. Patients were deemed noncompliant if they failed to take their medication more than 3 times in any month during the study period.

There were 5 patients lost to follow-up and another 5 died prior to completing the study.

Researchers found that although the pill burden was high, it showed a statistically significant decline over the observation period.

There was also a direct relationship between a patient’s age and their observed pill burden, likely due to a higher likelihood of comorbidities with increased age, the study noted.

Approximately 60.91% of participants were found to be fully compliant.

The pill burden for most patients was initially 10 to 32 after discharge following transplant and decreased to 7 to 28 at the end. Some patients even used parenteral and topical medications, as well.

Researchers also found no difference in noncompliance between patients treated in the government hospital and those treated in the private hospital.

Although patients treated in government hospitals are generally of a lower socioeconomic status, these results suggest that this may not directly affect adherence.

Since researchers were unable to prove that pill burden was a cause of noncompliance, they believe that lack of adequate caregiving support could be a factor, as was found in a different study with HIV/AIDS patients.

Researchers concluded that a search for other potential factors that impact noncompliance is needed in order to ensure a better long-term outcome for renal transplant patients.