Describing Predictors Of Regimen Nonadherence Among Kidney Recipients Using Multiple Measures

Aparna Balakrishnan*, Stacy Bailey, Daniel Mroczek, Marina Serper, Daniela Ladner, Michael Wolf

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Introduction: Many kidney recipients struggle with medication adherence and are at greater risk for adverse post-transplant outcomes. Historically, research has focused on single immunosuppressants alone, though all medications within a prescribed regimen are essential for positive outcomes. Research question: Explore predictors of medication regimen nonadherence among a diverse sample of adult kidney recipients by using multiple measures of adherence. Design: A cross-sectional analysis was performed using data from an ongoing clinical trial that enrolled 234 kidney recipients from a large transplant center. We used linear and logit regression models to examine associations of demographic characteristics, social determinants of health, and clinical characteristics with (a) self-reported regimen adherence, measured by the Adherence Starts with Knowledge 12 scale, and (b) immunosuppressant adherence, captured by calculated risk score based on Tacrolimus measurements. Results: Kidney recipients with limited health literacy, overall poorer health, and higher levels of depression demonstrated significantly poorer regimen adherence. Recipients who had dual public/private insurance, took a greater number of medications, and had shorter time since transplant demonstrated significantly poorer immunosuppressant adherence. Conclusion: Social determinants (health literacy and insurance status), and clinical characteristics (overall health status, depression, number of medications, and time since transplant) played significant roles in regimen and immunosuppressant adherence among kidney recipients in our sample. Self-reported adherence, particularly in relation to full medication regimens, can highlight modifiable barriers that might otherwise be overlooked by focusing on adherence to a single immunosuppressant. Depression and health literacy can be assessed and addressed to improve adherence among adult kidney recipients.

Original languageEnglish (US)
Pages (from-to)226-232
Number of pages7
JournalProgress in Transplantation
Issue number3
StatePublished - Sep 2022


  • chronic disease
  • kidney transplantation
  • medication adherence
  • medication compliance
  • social determinants of health

ASJC Scopus subject areas

  • Transplantation


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