Complementary Medicine Use, Symptom Burden and Non-Adherence in Kidney Transplant Recipients

Predictors of Treatment Adherence in Kidney Transplant Patients: A Systematic Review of the Literature

Background: Kidney transplantation (KTx) is a safe procedure that improves the life expectancy and quality of life of patients requiring it. However, despite the known benefits for patients who receive a kidney transplant, non-adherence to immunosuppressive medication is an unsolved problem, reflected mainly by graft rejection. Objective: The aim of this study is to systematically review the existing literature on adherence factors to medication after renal transplantation. Methods: A systematic literature review of studies published since 2010 was conducted in three databases. Records for the search were limited to publications from 2010 to 2024, available in full-text. The search was carried out in July 2024. In total, 2632 abstracts were downloaded from the different databases. Inclusion criteria were papers of any type (quantitative or qualitative) whose objective was the identification of predictors of adherence for patients who were prescribed immunosuppressive medication after kidney transplantation. Results: The predictors of adherence to treatment found in the systematic review were grouped into the following categories of the World Health Organization classification: socio-economic factors, factors related to the treatment/therapy, patient-related factors, disease-related factors, and health care system factors. Most of the studies were excluded, and in the end, 30 were included in the final analysis. According to these studies, a set of strong predictors was identified, but discrepancies among the variables of gender in young patients, pre-emptive transplantation, and the time of the transplantation were detected. Conclusions: In this study, we identified specific predictors and directions for the association of those predictors with adherence to immunosuppressive medication for patients after KTx. Further research should consider conducting reviews for different patient sub-groups on medication adherence and the development and validation of a screening instrument for adherence/non-adherence factors that clinicians could use as a detection tool for subjects at risk of low adherence.

Non-adherence to immunosuppressive medications in kidney transplant recipients- a systematic scoping review

BACKGROUND

Rejection and graft failure remain common in kidney transplant recipients. Non-adherence to immunosuppressive medications is considered a major contributary factor to reduced long-term graft survival, particularly in younger people. Improvements in clinical practice based on adherence studies has been minimal.

METHODS

Joanna Briggs' Institute Methodology was used. MedlineALL, Embase, Web of Science Core Collection and Scopus databases were searched from January 2000 through to December 2023. Abstract and full text reviews were undertaken independently by two reviewers. Data was collated using a pre-designed extraction tool.

RESULTS

359 articles met the inclusion criteria. Non-adherence was commonly defined using self-reported questionnaires or pharmacy re-fill rates. Prevalence of non-adherence varied widely. There was little correlation between method of measurement and reported rates of non-adherence. Despite younger age being identified as a risk factor for non-adherence, pooled reported prevalence did not differ significantly in studies reporting prevalence in children, adolescents, or young adults vs. older adults (36.0 % vs. 34.0 %). Interventional studies to detect or improve adherence are highly heterogenous, often report small effects and are limited by the lack of gold-standard methods to measure adherence.

DISCUSSION

This scoping review outlines the complexities of non-adherence to immunosuppressive medications among kidney transplant recipients, highlighting significant variability in adherence definitions, measurements, and intervention efficacy. Reported non-adherence rates vary widely (2-89 %), underscoring the need for standardisation of the definition of non-adherence in research. Findings suggest that non-adherence to immunosuppressive medication is driven by a mix of demographic, psychosocial, and transplant-specific factors. Future research should prioritise standardised definitions of adherence, validated tools to measure adherence, and focus on clinically significant outcomes in non-adherent populations to develop meaningful, impactful interventions for long-term patient benefit.

Utilization of complementary and alternative medicine by perimenopausal women in China: a cross-sectional study

OBJECTIVE

To investigate the utilization of complementary and alternative medicine (CAM) by perimenopausal women and explore factors associated with their preference.

METHODS

A cross-sectional study was conducted involving 558 perimenopausal women in Wuhan, China. Online questionnaires were available from December 2021 to April 2022. Instruments used were the International Complementary and Alternative Medicine Questionnaire and the Greene Climacteric Scale. The association between scores and participants' sociodemographic characteristics and perimenopausal symptoms was analyzed using multiple linear regression.

RESULTS

The overall utilization of CAM by perimenopausal women was 50.4% (281/558). Perimenopausal symptoms affecting the frequency of CAM usage included anxiety (adjusted β = 0.18), somatic (adjusted β = 0.07), and vasomotor symptoms (adjusted β = 0.76), P < 0.05. The most commonly used CAM were massage (37.7%), herbal therapies (19.9%), and dietary supplements (18.2%). Walking (58.6%) was the most popular self-practice therapy. Perimenopausal women consulted Western (38.4%) and Chinese medicine physicians (34.8%) and dentists (36.0%) most frequently.

CONCLUSIONS

Perimenopausal women experience discomforts during this age-related stage, and their use of CAM to manage symptoms is common. The usage and preferences of these management strategies are worthy of further exploration. There is a need to understand cost-effective and appropriate management interventions to improve the quality of life of perimenopausal women.

Complementary and alternative medicine use in an Australian kidney transplant recipient population

The prevalence of complementary and alternative medicine (CAM) use in kidney transplant recipients in Australia is unknown. Chronic transplant recipients completed a questionnaire, and participants who did not report CAM use also had medical chart audits. Among 127 participants, CAM use was reported by 26.8%, considerably lower than the general population. These findings may reflect underreporting due to misperception about what constitutes CAM (commonly vitamin use was not reported by the group denying CAM use), or perhaps a motivated population who are receptive to education efforts from the transplant team.

Patients' Experiences of Life Challenges After Liver Transplantation: A Qualitative Study

Patients experience a new life with different challenges after liver transplantation (LT). Identifying these challenges can facilitate the improvement of their quality of life. This study aimed to explore patients’ experiences of post-LT life challenges. This qualitative study was performed in 2019 through the content analysis approach. Participants were liver transplant recipients purposively recruited from a LT clinic. Semistructured interviews were conducted for data collection. Data were analyzed through Graneheim and Lundman’s conventional content analysis approach. Meaning units were identified and coded, and the codes were grouped into subcategories and categories according to their similarities. In total, 18 transplant recipients were interviewed. Their age mean was 51 years and their transplant age ranged from 4 months to 12 years. Their post-LT life challenges were categorized into 4 main categories, that is, self-care deficit, the need for seeking information, fears and concerns, and hope–despair duality. Nurses and members of LT team are recommended to assess transplant recipients’ life challenges and develop comprehensive plans for managing their challenges and problems and improving their quality of life.

Effect of Foot Reflexology on Pain, Fatigue, and Quality of Sleep after Kidney Transplantation Surgery: A Parallel Randomized Controlled Trial

MATERIALS AND METHODS

The study was a parallel randomized controlled trial. Patients admitted to the transplantation ward participated in the study. Fifty-three eligible patients were allocated into the foot reflexology group (n = 26) and the control group (n = 27) by using the stratified randomization method. Finally, 25 participants in each group finished the study. The intervention group received foot reflexology for 30 minutes once a day for three consecutive days, and no reflexology was applied in the control group. The intervention started on the second day after surgery. Pain, fatigue, and quality of sleep were measured on the first, second (before intervention), third, fourth, and eleventh days after surgery. Data were collected using visual analogue scale for measuring pain and fatigue and Verran and Snyder-Halpern sleep scale for measuring quality of sleep.

RESULTS

In each group, 25 patients finished the study. The mean pain score in the foot reflexology and control groups decreased from 9.44 ± 0.96 and 9.36 ± 0.91 on the day of surgery to 1.32 ± 0.94 and 4.32 ± 1.68 on the eleventh day after surgery, respectively. The mean fatigue score in the reflexology and control groups decreased from 8.76 ± 1.27 and 8.6 ± 1.26 on the day of surgery to 1.24 ± 1.2 and 3.92 ± 1.63 on the eleventh day after surgery, respectively. The mean sleep score in the foot reflexology and control groups increased from 33.38 ± 11.22 and 39.59 ± 12.8 on the day of surgery to 69.43 ± 12.8 and 56.27 ± 8.03 on the eleventh day after surgery, respectively. While pain, fatigue, and sleep quality scores improved in both groups, those in the intervention group showed significantly greater improvement compared with the control group (P < 0.001). No significant difference was found between the two groups in the use of acetaminophen on the first, second, third, fourth, and eleventh days after surgery (P > 0.05).

CONCLUSION

Foot reflexology may reduce pain and fatigue and improve sleep quality of patients after kidney transplantation.

Complementary and integrative medicine in kidney transplantation

PURPOSE OF REVIEW

Complementary and integrative medicine (CIM) use is widely prevalent in kidney transplant recipients but studies of efficacy or potential harm are sparse. This review examines prevalence of use of CIM and discusses potential beneficial and harmful aspects of CIM in renal transplant recipients.

RECENT FINDINGS

The prevalence of CIM use in kidney transplant patients varies from 12 to 45%. There is a knowledge gap regarding CIM modalities among healthcare professionals that may contribute to reluctance to discuss CIM use with patients. Patients often do not spontaneously disclose its use, and those that use it may be more likely to be nonadherent to allopathic therapies. Herbal supplements may be nephrotoxic or interact with pharmaceutical agents, including calcineurin inhibitors. More data are needed to assess the potential benefits of other modalities of CIM, including yoga, Tai Chi or meditation, as these modalities have been beneficial for people with diabetes or hypertension, both of which are common in the posttransplant period.

SUMMARY

Despite a high prevalence of CIM use in kidney transplant recipients, data are limited regarding risks and benefits. Education of healthcare providers who care for kidney transplant recipients should be encouraged. Intervention studies should be designed to investigate the CIM modalities, including yoga, meditation and Tai Chi that have been shown to be beneficial in other chronic diseases.