University of Hertfordshire

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Original languageEnglish
Number of pages9
JournalKidney International Reports
Journal publication date16 May 2019
Early online date16 May 2019
Publication statusE-pub ahead of print - 16 May 2019


Introduction: Non-adherence is common in both haemodialysis (HD) and kidney transplant recipients, and is a major risk factor for poor clinical outcomes. This retrospective study explored whether non-adherent HD patients become non-adherent transplant recipients. Methods: Data was collected for 88 patients from the electronic patient system at a sub-regional renal unit about adherence to HD regimens in the six months prior to transplantation, and for one-year post-transplantation following return transfer to the post-transplant clinic from the transplanting centre. Pre-transplant definitions of non-adherence included if patients: on average shortened their dialysis prescription by >10 minutes; shortened by >15 minutes; missed two or more HD sessions; and had mean serum phosphate levels >1.8mmol/l. Post-transplant definitions of non-adherence included: mean tacrolimus levels outside 5-10ng/mL; missed one or more post-transplant clinic appointments. Results: Non-adherence ranged from 25%-42% pre-transplant and 15.9%-22.7% post-transplant dependent on how it was operationalised. There was little relationship between pre-transplant data and post-transplant adherence, with the exception of a significant relationship between pre-transplant phosphate and post-transplant clinic attendance. Patients who had missed one or more transplant clinic appointments had higher mean pre-transplant phosphate levels. Non-adherent patients with high phosphate levels pre-transplant and missed clinic appointments post-transplant were significantly younger. Conclusion: Our findings provide little support for the likelihood of a strong direct relationship between pre and post-transplant behaviours. The findings require confirmation and further research to assess whether interventions in relation to pre-transplant adherence may enhance adherence post-transplant and improve outcomes.


© 2019 Published by Elsevier, Inc., on behalf of the International Society of Nephrology.

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