Relationship between the medication adherence with frailty and ehealth literacy in kidney transplant recipients

doi:10.3877/cma.j.issn.1674-3903.2025.03.009

Abstract

Abstract:

Objective

To investigate the current status of immunosuppressive medication adherence and its influencing factors among kidney transplant recipients, and to provide evidence for improving their medication adherence.

Methods

A convenience sampling method was used to recruit 244 kidney transplant recipients who visited Shulan (Hangzhou) Hospital Affiliated to Zhejiang Shuren University between January 2024 and June 2024. Data were collected through both paper-based and electronic questionnaires, including a general information survey, the basel assessment of adherence to immunosuppressive medication scale (BAASIS), fatigue resistance ambulation illnesses and loss of weight (FRAIL) scale and the ehealth literacy scale (eHEALS). For normally distributed continuous data, intergroup comparisons were performed using independent samples t-test or one-way analysis of variance. Pearson correlation analysis and multiple linear regression were performed to examine the relationship among immunosuppressive medication adherence, frailty, and ehealth literacy, as well as to identify factors influencing immunosuppressive medication adherence. P<0.05 was considered statistically significant.

Results

The valid response rate was 99.2% (242/244). The mean total BAASIS scores were (4.56±1.10), with 161 recipients (66.5%) demonstrating good adherence to immunosuppressive medication, while 81 (33.47%) exhibited suboptimal adherence in at least one aspect. The median FRAIL score was 0 (0-1), and the mean eHEALS scores were (19.64±5.91). Significant differences in immunosuppressive medication adherence of BAASIS scores were observed across age groups, marital status, and time since transplantation (t=3.925, 4.358 and 5.855, all P<0.05). Immunosuppressive medication adherence was positively correlated with frailty (r=0.182, P<0.05). Multiple linear regression analysis identified that the frailty as a risk factor for poor immunosuppressive medication adherence (P<0.05).

Conclusion

Immunosuppressive medication adherence among kidney transplant recipients remains suboptimal, with frailty being a significant risk factor.

Key words: Renal transplantation, Immunosuppressive agent, Medication adherence, Frailty, Ehealth literacy

Jing Xu, Tian He, Xiaojia Shen, Shumin Wang, Linyan Wu, Mingyan Shen, Zhangfei Shou. Relationship between the medication adherence with frailty and ehealth literacy in kidney transplant recipients[J]. Chinese Journal of Transplantation(Electronic Edition), 2025, 19(03): 170-174.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://zhyzzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1674-3903.2025.03.009

https://zhyzzz.cma-cmc.com.cn/EN/Y2025/V19/I03/170

Figures/Tables 3

References 26

1	沈鸣雁，韩琳秋，徐菁，等. 肾移植患者免疫抑制剂服药依从性管理审查指标的制订及障碍因素分析[J]. 中华护理杂志，2024，59(10)：1205-1211.
2	Mellon L, Doyle F, Hickey A, et al. Interventions for increasing immunosuppressant medication adherence in solid organ transplant recipients[J]. Cochrane Database Syst Rev, 2022，9 (9)：CD012854.
3	Balakrishnan A, Weinmeyer R, Serper M, et al. Navigating medication-taking after kidney transplant[J]. Res Social Adm Pharm, 2022, 18(10): 3846-3854.
4	Gokoel SRM, Gombert-Handoko KB, Zwart TC, et al. Medication non-adherence after kidney transplantation: a critical appraisal and systematic review[J]. Transplant Rev (Orlando), 2020, 34(1): 100511.
5	Singh N, Samant H, Hawxby A, et al.Biomarkers of rejection in kidney transplantation[J]. Curr Opin Organ Transplant，2019，24(1)：103-110.
6	Wang W, Teng Y, Xue JJ，et al.Nanotechnology in kidney and islet transplantation: an ongoing, promising field[J]. Front Immunol，2022，13：846032.
7	Bonikowska I, Szwamel K, Uchmanowicz I. Adherence to medication in older adults with type 2 diabetes living in Lubuskie Voivodeship in Poland: association with frailty syndrome[J]. J Clin Med, 2022, 11(6): 1707
8	林丽玉，许丽春，钟玉凤，等. 社区老年高血压患者衰弱与服药依从性的相关性分析[J]. 老年医学研究，2021，2(4)：35-39.
9	Cao H, Zhang J, Sun Z, et al. Frailty in kidney transplant candidates and recipients: pathogenesis and intervention strategies[J]. Chin Med J (Engl), 2023, 136(9): 1026-1036.
10	Jung SO, Son YH, Choi E. E-health literacy in older adults: an evolutionary concept analysis[J]. BMC Med Inform Decis Mak, 2022, 22(1): 28.
11	Maroney K, Curtis L M, Opsasnick L, et al. eHealth literacy and web‐based patient portal usage among kidney and liver transplant recipients[J]. Clin Transplant, 2021, 35(2): e14184.
12	Zachciał J, Uchmanowicz I, Krajewska M, et al. Adherence to immunosuppressive therapies after kidney transplantation from a biopsychosocial perspective: a cross-sectional study[J]. J Clin Med, 2022, 11(5): 1381.
13	Leasel Reseuven-Barch Group.Basel Assessment of Adherence to Immunosuppressive Medications Scale, 2005[EB/OL]. (2005-05-11)[2024-10-06]. URL
14	中华医学会老年医学分会，郝秋奎，李峻，等. 老年患者衰弱评估与干预中国专家共识[J]. 中华老年医学杂志，2017，36(3)：251-256.
15	周寒寒，王静，李岩. 中文版电子健康素养量表在我国社区老年人群中的信效度初步分析[J]. 医药高职教育与现代护理，2019，2(6)：448-451.
16	Tielen M, van Exel J, Laging M, et al. Attitudes to medication after kidney transplantation and their association with medication adherence and graft survival: a 2-year follow-up study[J]. J Transplant, 2014, 2014: 675301.
17	刘路浩，苏泳鑫，曾丽娟，等. 新型冠状病毒感染疫情期间肾移植受者免疫抑制剂服药依从性研究[J/OL]. 中华移植杂志：电子版，2023，17(3)：140-145.
18	姜春英，胡锦芳，邹德琴. 同种异体肾移植术后病人口服他克莫司的依从性与社会支持的相关性分析[J]. 全科护理，2022，20(30)：4261-4265.
19	张心怡，吕军好，陈大进. 2023年肾移植领域研究进展[J/OL]. 中华移植杂志：电子版，2024，18(1)：7-11.
20	Russell CL, Hathaway D, Remy LM, et al. Improving medication adherence and outcomes in adult kidney transplant patients using a personal systems approach: SystemCHANGE™ results of the MAGIC randomized clinical trial[J]. Am J Transplant, 2020, 20(1): 125-136.
21	丛雯亓，吴晴航，崔瑜，等. 儿童肾移植受者移植术后一年内发生急性排斥反应的影响因素及预后分析[J]. 中华器官移植杂志，2023，44(2)：94-101.
22	游丽娟，钟超，雷芬，等. 器官移植患者术后服用免疫抑制剂依从性的相关研究进展[J/OL]. 实用器官移植电子杂志，2020，8(3)：237-242.
23	沈鸣雁．成人肾移植患者免疫抑制剂服药依从性管理的证据总结[J]. 中华护理杂志，2023，58(18)：2207-2215.
24	Griva K, Neo HLM, Vathsala A. Unintentional and intentional nonadherence to immunosuppressive medications in renal transplant recipients[J]. Int J Clin Pharm, 2018，40(5)：1234-1241.
25	Zachciał J, Uchmanowicz I, Krajewska M, et al. Adherence to immunosuppressive therapies after kidney transplantation from a biopsychosocial perspective: a cross-sectional study[J]. J Clin Med, 2022, 11(5): 1381.
26	邵明，董奥奇，刘欢，等. 中老年慢性病患者服药依从性风险列线图模型的构建与验证[J]. 济宁医学院学报，2025，48(1)：32-37.

条目	完全依从[例(%)]	不完全依从[例(%)]	分值(分，±s)
漏服药	207(85.5)	35(14.5)	1.20±0.55
连续漏服药	235(97.1)	7( 2.9)	1.03±0.17
不按时服药	191(78.9)	51(21.1)	1.32±0.69
未按医嘱剂量服药	239(98.8)	3( 1.2)	1.02±0.16
未经医师指导自行停止用药	224(92.6)	18( 7.4)	－
合计	161(66.5)	81(33.5)	4.56±1.10

条目	完全依从[例(%)]	不完全依从[例(%)]	分值(分，±s)
漏服药	207(85.5)	35(14.5)	1.20±0.55
连续漏服药	235(97.1)	7( 2.9)	1.03±0.17
不按时服药	191(78.9)	51(21.1)	1.32±0.69
未按医嘱剂量服药	239(98.8)	3( 1.2)	1.02±0.16
未经医师指导自行停止用药	224(92.6)	18( 7.4)	－
合计	161(66.5)	81(33.5)	4.56±1.10

项目	例数	BAASIS得分(分，±s)	t/F值	P值
性别			0.501	>0.05
男	162	4.54±1.07
女	80	4.61±1.16
年龄(岁)			3.925	<0.05
≤50	145	4.68±1.20
>50	97	4.39±0.91
文化程度			1.044	>0.05
小学及以下	27	4.63±1.21
初中	70	4.14±0.86
中专/高中	50	4.57±1.14
大专	47	4.38±0.80
本科及以上	48	4.81±1.50
婚姻状况			4.358	<0.05
已婚	210	4.51±1.03
其他	32	4.94±1.46
工作状况			0.004	>0.05
在职	136	4.57±1.02
其他	106	4.57±1.20
移植术后时间(年)			5.855	<0.05
≤2	101	4.35±0.93
>2	141	4.69±1.18
付费方式			0.265	>0.05
医保	236	4.57±1.11
自费	6	4.33±0.52

项目	例数	BAASIS得分(分，±s)	t/F值	P值
性别			0.501	>0.05
男	162	4.54±1.07
女	80	4.61±1.16
年龄(岁)			3.925	<0.05
≤50	145	4.68±1.20
>50	97	4.39±0.91
文化程度			1.044	>0.05
小学及以下	27	4.63±1.21
初中	70	4.14±0.86
中专/高中	50	4.57±1.14
大专	47	4.38±0.80
本科及以上	48	4.81±1.50
婚姻状况			4.358	<0.05
已婚	210	4.51±1.03
其他	32	4.94±1.46
工作状况			0.004	>0.05
在职	136	4.57±1.02
其他	106	4.57±1.20
移植术后时间(年)			5.855	<0.05
≤2	101	4.35±0.93
>2	141	4.69±1.18
付费方式			0.265	>0.05
医保	236	4.57±1.11
自费	6	4.33±0.52

变量	偏回归系数	标准误	β值	t值	P值
常量	4.475	0.557	－	8.520	0.000
年龄>50岁	－0.014	0.008	－0.136	－1.825	0.069
婚姻状况(其他)	0.191	0.238	0.059	0.802	0.424
移植术后时间>2年	0.040	0.025	0.100	1.570	0.118
衰弱总分(分)	0.238	0.076	0.201	3.145	0.002

Please choose a citation manager

Content to export