La adherencia terapéutica en el paciente trasplantado renal

Abstract

In patients with chronic kidney disease who have a kidney transplant, adherence to treatment is crucial to prevent rejection, graft loss and additional morbility. Objective: to know current scientific production on adherence to treatment by kidney transplant patients and the variables that can affect it. Method: A search was conducted in the databases of Scielo, PubMed, The Chocrane, Science Direct and Google Scholar. Scientific articles written in English and Spanish were included. Articles that dealt with adherence to immunosuppressive treatment by kidney transplant patients were analysed, excluding paediatric patients. Results: Adherence to immunosuppressive treatment by these patients is relatively low due to the influence of several factors. The complexity of the treatment and time after the transplant have an important negative correlation to adherence. Forgetfulness or other occupations are related significantly to unintentional non-adherence by patients. The age groups with the lowest adherence are the youngest followed by the most elderly, while the most adherent are adults. In some countries, the lack of adherence is due to the fact that the high cost of the immunosuppressive treatment has to be paid by the patient. On the other hand, variables that do not appear to have a conclusive influence are: marital status or lifestyle, side effects, socio-economic and educational level, job situation, race, beliefs about their necessity and psychological factors. Finally, the variable of gender is clearly the only one that does not affect lack of adherence, as most studies show that gender does not influence adherence compared to only two that consider that men are less adherent. Conclusions: kidney transplant patients present higher percentages of lack of adherence to treatment, fundamentally related to the complexity of the treatment, the time since the transplant, forgetfulness, or other occupations and age (young and elderly).