Medication understanding, non-adherence, and clinical outcomes among adult kidney transplant recipients

Rachel E. Patzer*, Marina Serper, Peter P. Reese, Kamila Przytula, Rachel Koval, Daniela P. Ladner, Josh M. Levitsky, Michael M. Abecassis, Michael S. Wolf

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

79 Scopus citations


We sought to evaluate the prevalence of medication understanding and non-adherence of entire drug regimens among kidney transplantation (KT) recipients and to examine associations of these exposures with clinical outcomes. Structured, in-person interviews were conducted with 99 adult KT recipients between 2011 and 2012 at two transplant centers in Chicago, IL; and Atlanta, GA. Nearly, one-quarter (24%) of participants had limited literacy as measured by the Rapid Estimate of Adult Literacy in Medicine test; patients took a mean of 10 (SD=4) medications and 32% had a medication change within the last month. On average, patients knew what 91% of their medications were for (self-report) and demonstrated proper dosing (via observed demonstration) for 83% of medications. Overall, 35% were non-adherent based on either self-report or tacrolimus level. In multivariable analyses, fewer months since transplant and limited literacy were associated with non-adherence (all P<.05). Patients with minority race, a higher number of medications, and mild cognitive impairment had significantly lower treatment knowledge scores. Non-white race and lower income were associated with higher rates of hospitalization within a year following the interview. The identification of factors that predispose KT recipients to medication misunderstanding, non-adherence, and hospitalization could help target appropriate self-care interventions.

Original languageEnglish (US)
Pages (from-to)1294-1305
Number of pages12
JournalClinical Transplantation
Issue number10
StatePublished - Oct 1 2016


  • cognition
  • hospitalization
  • kidney transplantation
  • literacy
  • medication adherence

ASJC Scopus subject areas

  • Transplantation


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