Date: Tuesday, May 5, 2015
Session Time: 5:30pm-6:30pm
Presentation Time: 5:30pm-6:30pm
Location: Exhibit Hall E
Background: Medication adherence in adolescent kidney transplant (KT) recipients is poor, with non-adherence (NA) ranging from 5-71%, and NA is associated with poor graft survival. Adherence in children with chronic kidney disease (CKD) is currently not well described, however assessment is worthwhile as it may be associated with adherence post-kidney transplant. It is important to identify appropriate measures of adherence to identify patients at risk for NA. This study is aimed at comparing two measures of medication adherence.
Methods: 78 teens from 3 medical centers, age 11-19 with KT or CKD and prescribed antirejection and/or antihypertensive medication, and their caregiver completed the Morisky Adherence Scale. Categories of adherence based on the number of affirmative responses: low adherence = >2, medium adherence = 1 or 2, high adherence = 0. Provider-perceived adherence was determined post-clinic visit, with adherent defined as ≥75% and NA as ˂75%. Chi-squared analyses and kappa statistics were used to compare patient/caregiver-reported to provider-perceived adherence.
Results: Patient-mean age 14.7yrs; 46% female; 44% Caucasian, 45% Black; 79% CKD, 21% KT. Caregiver-77% female, 31% household income <$50,000/yr. Provider-n=18; 72% female.
Providers perceived 64% of patients as adherent while 8%, 39% and 53% of teens reported themselves as high, medium and low adherent and parents reported 18% high, 28% medium and 54% low adherence. There were no significant differences in patient/caregiver demographics between those perceived by the provider as adherent vs. NA.
Agreement between provider and teen (27% agreement; kappa -0.12±0.04) and provider and caregiver (23% agreement; kappa -0.19±0.04) was poor. Positive predictive value (PPV) of provider-perceived adherence was 58% and negative predictive value (NPV) was 75% when compared to patient-reported adherence, and compared to caregiver report, PPV was 64% and NPV was 89%.
Conclusions: Providers overestimate medication adherence for many adolescents with KT or CKD and their ability to identify NA is worse than that expected to occur by chance alone. Use of a simple adherence measure, like the Morisky Scale, may help identify NA in this vulnerable population.
To cite this abstract in AMA style:Pruette C, Brady T, Mendley S, Fivush B, Tuchman S, Green A, Eakin M, Riekert K. Medication Adherence in Adolescents With Kidney Transplant and Chronic Kidney Disease: Patient/Caregiver Report Vs. Provider Perception [abstract]. Am J Transplant. 2015; 15 (suppl 3). https://atcmeetingabstracts.com/abstract/medication-adherence-in-adolescents-with-kidney-transplant-and-chronic-kidney-disease-patientcaregiver-report-vs-provider-perception/. Accessed November 24, 2020.
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