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10 May 2019 : Original article  

Prediction of Nonadherence and Renal Prognosis by Pre-Transplantation Serum Phosphate Levels

Mineaki Kitamura12ABCDEF*, Yasushi Mochizuki13ABD, Satoko Kitamura12BD, Yuta Mukae3BD, Hiromi Nakanishi3B, Yuki Ota2B, Kumiko Muta2B, Hiroshi Yamashita2BD, Yoko Obata2DEF, Takahisa Iwata4B, Masaharu Nishikido5BD, Sachiko Kawanami6D, Miwa Takashima7D, Hitoshi Sasaki8DE, Hideki Sakai13DE, Hiroshi Mukae9D, Tomoya Nishino2ADEF

DOI: 10.12659/AOT.914909

Ann Transplant 2019; 24:260-267

Abstract

BACKGROUND: Identifying characteristics of patients at high risk of poor adherence before transplantation would be advantageous. However, the optimal approach for characterizing such patients remains unknown. We aimed to evaluate the association between factors for hemodialysis nonadherence and post-transplant renal prognosis. We hypothesized that these factors would influence post-transplantation adherence and worsen renal prognosis.

MATERIAL AND METHODS: We reviewed patients on hemodialysis who underwent kidney transplantation at our hospital between 2000 and 2017 to identify risk factors associated with poor prognosis. The patients’ background and pre-transplantation data, known hemodialysis nonadherence factors, serum phosphate and potassium levels, and interdialytic weight gains were evaluated. The primary endpoint was renal death. We also evaluated the fluctuation of calcineurin inhibitor concentration and weight gain after transplantation.

RESULTS: Seventy-seven patients were eligible, and the mean observational period was 83.2 months (standard deviation, 50.5). Thirteen patients reached the endpoint. Cox proportional hazards regression analysis showed that pre-transplantation serum phosphate level was a risk factor for renal death (p<0.05), while serum potassium levels and weight gain were not. In addition, fluctuation of calcineurin inhibitor concentration was observed in patients with higher phosphate levels before transplantation (p=0.03). Weight gain after transplantation was not associated with the hemodialysis nonadherence factors.

CONCLUSIONS: High pre-transplantation serum phosphate levels are considered to represent poor drug adherence and/or an unhealthy lifestyle. Patient education that conveys the importance of adhering to medications and provides nutritional guidance is crucial for improving post-transplantation renal prognosis.

Keywords: Dialysis, Kidney Transplantation, medication adherence, Patient Compliance, Kidney Failure, Chronic, Life Style, Phosphates, Renal Dialysis, Risk Factors, Weight Gain

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Annals of Transplantation eISSN: 2329-0358
Annals of Transplantation eISSN: 2329-0358