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Titolo:
The natural history of azathioprine compliance after renal transplantation
Autore:
Nevins, TE; Kruse, L; Skeans, MA; Thomas, W;
Indirizzi:
Univ Minnesota, Sch Med, Dept Pediat, Minneapolis, MN 55455 USA Univ Minnesota Minneapolis MN USA 55455 Pediat, Minneapolis, MN 55455 USA Univ Minnesota, Sch Med, Dept Surg, Minneapolis, MN 55455 USA Univ Minnesota Minneapolis MN USA 55455 t Surg, Minneapolis, MN 55455 USA Univ Minnesota, Sch Med, Dept Biostat, Minneapolis, MN 55455 USA Univ Minnesota Minneapolis MN USA 55455 iostat, Minneapolis, MN 55455 USA
Titolo Testata:
KIDNEY INTERNATIONAL
fascicolo: 4, volume: 60, anno: 2001,
pagine: 1565 - 1570
SICI:
0085-2538(200110)60:4<1565:TNHOAC>2.0.ZU;2-V
Fonte:
ISI
Lingua:
ENG
Soggetto:
PATIENT COMPLIANCE; SUBCLINICAL NONCOMPLIANCE; MEDICATION COMPLIANCE; SELF-REPORT; RECIPIENTS; ADHERENCE; THERAPY; CYCLOSPORINE; HYPERTENSION; REJECTION;
Keywords:
medication adherence; kidney transplant; organ rejection; electronic monitor; acute renal failure; allograft loss; drug monitoring;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Life Sciences
Citazioni:
27
Recensione:
Indirizzi per estratti:
Indirizzo: Nevins, TE Univ Minnesota, Sch Med, Dept Pediat, 420 Delaware St SE, MMC 491, Minneapolis, MN 55455 USA Univ Minnesota 420 Delaware St SE, MMC 491 Minneapolis MN USA 55455
Citazione:
T.E. Nevins et al., "The natural history of azathioprine compliance after renal transplantation", KIDNEY INT, 60(4), 2001, pp. 1565-1570

Abstract

Background. Successful renal transplantation requires longterm adherence to complex medical regimens, yet knowledge of post-transplant medication compliance is still inadequate. Methods. The natural history of medication compliance was quantitatively documented using electronic medicine bottle monitors. Azathioprine use was recorded with medication monitors beginning at hospital discharge in a prospective cohort of 180 renal transplant recipients. These patients and 87 other eligible patients, declining study participation, were followed up to five years. Compliance rates were associated with discrete clinical outcomes:acute rejection, allograft loss, and death. Results. During the first six months, only 8% of all azathioprine doses were missed. However, individual compliance rates varied widely, ranging from16 to 100%, and each month, on average, 18% of patients skipped medicationfor four or more days. Outcome events were not different between study participants and those refusing study. However, lower compliance rates during the first six months were associated in a "dose-response" fashion with acute rejection (P = 0.006) and allograft loss (P = 0.002). Declining compliance during the first 90 days was a strong risk factor both for later acute rejection (odds ratio = 13.9. 95% CI. 2.9 to 68, P = 0.001), and allograft loss (odds ratio = 4.3, 95% CI, 1.1 to 16, P = 0.032). Conclusions. Electronic monitoring provides a temporal description and quantitation of medication compliance. Reduced azathioprine compliance was highly associated with acute rejection and allograft loss. Trends in early compliance behavior predict later outcomes, thus providing unique opportunities for intervention.

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Documento generato il 31/05/20 alle ore 11:32:57