Não aderência farmacológica e não farmacológica em transplantados renais no Brasil: resultados do estudo multicêntrico ADERE Brasil

Abstract

Introduction: Pharmacologic and nonpharmacologic adherence after kidney transplantation contributed to the worsening of long-term graft survival. Understanding nonadherence to immunosuppressives and health behaviors such as physical activity, smoking, alcohol use and frequent visits (nonpharmacologic adherence) is fundamental to propose interventions. Brazil, with the largest public transplant program in the world and with regional differences in transplantation activity, is in a unique position to study this approach. Objectives: To identify the prevalence and variability of nonadherence to immunosuppressives and nonpharmacologic treatment in Brazilian services and regions and to describe the strategies used to manage the ADERE Brasil study. Methods: An observational and multicenter study that included 20 Brazilian kidney transplant centers. The centers were chosen for convenience, following multistage sampling strategy, based on strata, considering the following characteristics: center (low / moderate / high) transplantation activity and regions (South / Southeast and Northeast / North / Mid-West) . Patient selection was randomized and proportional to the size of the center within each stratum. The prevalence of nonadherence to immunosuppressive treatment was assessed using the self-report instrument, the Basel Assessment of Adherence to Immunosuppressive Medications Scale (BAASIS). To evaluate the nonpharmacologic adherence, the patient was considered no adherent to the physical activity the patient who did less than 150 minutes per week, to smoking the one who smoked in the period of data collection, to alcohol due to excessive consumption and frequency of appointment keeping that lacked more than one of the last five scheduled, using instruments established for this purpose. Data were collected over a period of 24 months, with information obtained during the regular visits to the transplant outpatient clinic in the Electronic Research Data System. Data entry was performed by a trained professional of the transplant service team. Data collection began in December 2015 and ended in June 2017. For statistical analysis, the adjusted chi-square test and t test was used. Results: A total of 1,105 patients were included in the study. 58.5% of the patients were male, 51.4% were white, age 47.5 ± 12.6 years. Of the services, 75.9% were from the south / southeast region, 38.2% performed <50 transplants / year and 95.8% had a multiprofessional team. The prevalence of non-adherence in Brazil and in the regions (South / Southeast vs. North / Northeast / Mid-West) were respectively: for immunosuppressives 39.7%; 38.1% vs. 44.9%, p = 0.18; for smoking 3.9%; 5% vs. 1%, p <0.001; for physical activity 69.1%; 69% vs. 71%, p = 0.48; appointment keeping 12.7%; 13% vs. 12%, p = 0.77 and 0% for alcohol consumption. Nonadherence in services ranged from 11 to 65.2% for immunosuppressives; 44.5 to 90% to FA; 0 to 23.7% to FC; 0 to 14% to smoking. Conclusion: This is the first study about the prevalence and variability of nonadherence to kidney transplant treatment in the Brazilian regions. Despite the differences between the centers and great variability, only the nonadherence to smoking was greater in the region of greater access to renal transplantation.