Nonadherence Behaviors and Some Related Factors in Kidney Transplant Recipients

Pari Hedayati, Nahid Shahgholian, Ahmad Ghadami


Background: Kidney transplantation is the renal replacement therapy of choice for most patients with end‑stage renal disease (ESRD), however, adherence to the recommended lifestyle is critical for a positive prognosis. The purpose of this study was to assess adherence to immunosuppressive therapy and lifestyle recommendations along with some related factors among kidney transplant patients.
Materials and Methods: In this descriptive analytical study, all patients completed a questionnaire regarding medication intake and lifestyle recommendations (preventing of infection, self‑monitoring, prevention of cardiovascular disease (CVD), and sun protection). The participants were divided into 4 groups according to the level of adherence (good, partial, poor, and nonadherent) indicated in their responses.

Results: Most kidney recipients were adherent to their drug prescriptions, but were partial, poor, or nonadherent regarding lifestyle recommendations. Increased passage of time since transplantation and low family support and educational level resulted in nonadherence. Men showed greater adherence to medication intake than women. Patients with lower number of drugs and reported drug side‑effects illustrated better adherence to medication intake. Women adhered to infection protection recommendations more than men, and older and married patients adhered to cardiovascular prevention recommendations more than others. However, younger patients showed greater adherence to self‑monitoring recommendations, and singles, young individuals, and women were adherent to sun protection recommendations.

 Conclusions: Nonadherence is common among kidney transplant recipients. Thus, it is necessary to determine patients who are at risk of nonadherence and to introduce more educational programs to improve their adherence and their quality of life (QOL).


Adherence; Iran; Kidney transplantation nursing

Full Text:



Namdar A, Beigizadeh SH, Najafipour S. Health related quality of life in dialysis patients. J Jahrom Univ Med Sci 2013;10:16 24.

Tayyebi A, Raiesifar A, Najafi Mehri S, Ebadi A, Einolahi B, Pashandi SH. Measuring Health Related Quality of Life (Hrqol) in Renal Transplant Patients: Psychometric Properties and Cross Cultural Adaptation of Kidney Transplant Questionnaire (Ktq 25) in Persian. Nephrourol Mon 2012;4:617 21.

Tabatabai SA, Hashemi SM, Zandi M. Frequency distribution of long time complications of renal transplantation in Alzahra hospital. J Isfahan Med School 2011;28:1 10.

Germani G, Lazzaro S, Gnoato F, Senzolo M, Borella V, Rupolo G, et al. Nonadherent behaviors after solid organ transplantation. Transplant proc 2011;43:318 23.

Green M. Introduction: Infections in solid organ transplantation. Am J Transplant 2013;13:3 8. 6. Shirali AC, Bia MJ. Management of cardiovascular disease in renal transplant recipients. Clin J Am Soc Nephrol 2008;3:491 504.

Shirali AC, Bia MJ. Management of cardiovascular disease in renal transplant recipients. Clin J Am Soc Nephrol 2008;3:491‑504.

Diao DY, Lee TK. Sun protective behaviors in populations at high risk for skin cancer. Psychol Res Behav Manag 2013;7:9 18.

Marsicano Ede O, Fernandes Nda S, Colugnati F, Grincenkov Frd S, Fernandes NM, De Geest S, et al. Transcultural adaptation and initial validation of Brazilian Portuguese version of the Basel assessment of adherence to immunosuppressive medications scale (BAASIS) in kidney transplants. BMC Nephrol 2013;14:108.

Shellmer DA, Dabbs AD, Dew MA. Medical adherence in pediatric organ transplantation: What are the next steps? Curr Opin Organ Transplant 2011;16:509 14.

Lennerling A, Forsberg A. Self reported non adherence and beliefs about medication in a Swedish kidney transplant population. Open Nurs J 2012;6:41 6.

Giardini A, Pierobon A, Majani G, Biffa G, Volpe B, Sala A, et al. Adherence self report assessment in solid organ pre and post transplant recipients. G Ital Med Lav Ergon 2011;33:69 76.

Williams A.F, Manias E, Gaskin C.J, Crawford K. Medicine non adherence in kidney transplantation. J Ren Care 2014;40:107 16.

Kobus G, Małyszko J, Małyszko JS, Puza E, Bachórzewska Gajewska H, Mysliwiec M. Compliance with lifestyle recommendations in kidney allograft recipients. Transplant proc 2011;43:2930 4.

Gheith OA, El Saadany SA, Abuo Donia SA, Salem YM. Compliance with recommended life style behaviors in kidney transplant recipients: Does it matter in living donor kidney transplant? Iran J Kidney Dis 2008;2:218 26.

Prendergast M.B, Gaston R.S. Optimizing Medication Adherence: An Ongoing Opportunity To Improve Outcomes After Kidney Transplantation. Clin J Am Soc Nephrol 2010;5:1305 11.

Blanca Martínez Pérez A, López Suárez A, Rodríguez Rodríguez J, Sobrino Márquez J.M, Lage Gallé E. Medication Adherence in Patients Who Undergo Cardiac Transplantation. Transplant proc 2013;45:2662 4.

McCune KR. Nonadherence to Immunosuppressive Medication: New Insights. Immunology 2013;10:22 5.

Prihodova L, Nagyova I, Rosenberger J, Majernikova M, Roland R, Groothoff JW, et al. Adherence in patients in the first year after kidney transplantation and its impact on graft loss and mortality: A cross sectional and prospective study. J Adv Nurs 2014;70:2871 83.

Shabany Hamedan M, Mohammad Aliha J, SHekarabi R, Hosseini AF. Relationship between adherence to medication regimen and quality of life in renal transplant patients. Iran J Nurs 2010;23:29 34.

Kugler C, Geyer S, Gottlieb J, Simon A, Haverich A, Dracup K. Symptom experience after solid organ transplantation. J Psychosom Res 2009;66:101 10.

Denhaerynck K, Dobbels F, Cleemput I, Desmyttere A, Schafer Keller P, Schaub P, et al. Prevalence, consequences, and determinants of nonadherence in adult renal transplant patients. Transpl Int 2005;1121 33.

Morales JM, Varo E, Lazaro P. Immunosuppressant treatment adherence, barriers to adherence and quality of life in renal and liver transplant recipients in Spain. Clin Transplant 2012;26:369 76.

Urstad KH. Patient Education for Renal Transplant Recipients. Doctoral Thesis, Faculty of Medicine, University of Oslo, Norway; 2013.

Dew MA, DiMartini AF, De Vito Dabbs A, Myaskovsky L, Steel J, Unruh M, et al. Rates and risk factors for nonadherence to the medical regimen after adult solid organ transplantation. Transplantation 2007;83:858 73.

Nourbala MH, Nemati E, Rostami Z, Einollahi B. Impact of cigarette smoking on kidney transplant recipients: A systematic review. Iran J Kidney Dis 2011;5:141 8. 26. Firooz A, Amin Nejad R, Bouzari N, Nafar M, Firoozan A, Mahdavi Mazdeh M. Sun protection in Iranian kidney transplant recipients: Knowledge, attitude and practice. J Eur Acad Dermatol Venereol 007;21:754 7.

Firooz A, Amin‑Nejad R, Bouzari N, Nafar M, Firoozan A, Mahdavi‑Mazdeh M. Sun protection in Iranian kidney transplant recipients: Knowledge, attitude and practice. J Eur Acad Dermatol Venereol 2007;21:754‑7.

Ulrich C, Ju¨rgensen J.S, Degen A, Hackethal M, Ulrich M, Patel M.J, et al. Prevention of non melanoma skin cancer in organ transplant patients by regular use of a sunscreen: A 24 months, prospective, case–control study. Br J Dermatol 2009;161:78 84.

Clowers Webb HE, Christenson LJ, Phillips PK, Roenigh RK, Nguyen TH, Weavwe AL, et al. Educational outcomes regarding skin cancer in organ transplant recipients: Randomized intervention of intensive vs. standard education. Arch Dermatol 2006;142:712 8.

Massey EK, Tielen M, Laging M, Beck DK, Khemai R, van Gelder T, et al. The role of goal cognitions, illness perceptions and treatment beliefs in self reported adherence after kidney transplantation: A cohort study. J Psychosom Res 2013;229 34


  • There are currently no refbacks.