Faculty Collaboration Database

The Impact of Health Care Appointment Non-Adherence on Graft Outcomes in Kidney Transplantation. Am J Nephrol 2017;45(1):91-98

Date

12/03/2016

Pubmed ID

27907919

Pubmed Central ID

PMC5214896

DOI

10.1159/000453554

Scopus ID

2-s2.0-85001610269 (requires institutional sign-in at Scopus site)   39 Citations

Abstract

BACKGROUND: Non-adherence to medication is a well-studied and known cause of late allograft loss, but it is difficult to measure and prospectively monitor. The aim of this study was to assess if appointment non-adherence was correlated with medication non-adherence and a predictor of graft outcomes.

METHODS: This was a longitudinal cohort study that used the National United States Renal Data System and veterans affairs health records data with time-to-event analyses conducted to assess the impact on graft and patient survival.

RESULTS: The number of transplants that were included in the analysis was 4,646 (3,656 with complete records); 14.6% of patients had an appointment no show rate of ≥12% (non-adherence). Appointment and medication non-adherence were highly correlated and both were significant independent predictors of outcomes. Those with appointment non-adherence had 1.5 times the risk of acute rejection (22.0 vs. 14.7%, p < 0.0001) and a 65% higher risk of graft loss (adjusted hazards ratio (aHR) 1.65, 95% CI 1.38-1.97, p < 0.0001). There was a significant interaction between appointment and medication non-adherence; those with appointment and medication non-adherence were at very high risk of graft loss (aHR 4.18, 95% CI 3.39-5.15, p < 0.0001), compared to those with only appointment non-adherence (aHR 1.39, 95% CI 0.97-2.01, p = 0.0766) or only medication non-adherence (aHR 2.44, 95% CI 2.11-2.81, p < 0.0001).

CONCLUSION: These results demonstrate that non-adherence to health care appointments is a significant and independent risk factor for graft loss.

Author List

Taber DJ, Fleming JN, Fominaya CE, Gebregziabher M, Hunt KJ, Srinivas TR, Baliga PK, McGillicuddy JW, Egede LE

Author

Leonard E. Egede MD Center Director, Chief, Professor in the Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Aged
Appointments and Schedules
Delayed Graft Function
Female
Graft Rejection
Graft Survival
Humans
Immunosuppressive Agents
Kidney Failure, Chronic
Kidney Transplantation
Longitudinal Studies
Male
Medication Adherence
Middle Aged
No-Show Patients
Proportional Hazards Models
Retrospective Studies
Risk Factors
Survival Rate
United States
Veterans