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Quantifying the medication burden of kidney transplant recipients in the first year post-transplantation

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Abstract

Background Kidney transplantation is an effective treatment, but it is not a cure. Since the risk of graft rejection and the presence of comorbid conditions remain for a lifetime, medications are necessary. Objective To examine the prescription medication burden of adult kidney transplant recipients from 3- to 12-months post-transplantation. Setting All five adult kidney transplant units in Victoria, Australia. Method As part of a larger intervention study, we conducted a retrospective review of prescription refill records and medical records containing the history of medication changes of 64 participants who completed the study. The complexity of the medication management was studied, and we looked at the burden of maintaining the medications supply. Outcome measures Pill burden, administration frequency, dose changes frequency, immunosuppressive medication changes, the estimated out-of-pocket costs of medications and frequency of pharmacy visits. Results At 3 months, the average daily pill burden was 22 (SD = 9) whilst at 12 months, it was 23 (SD = 10). Some participants required long-term prophylaxis of fungal infections up to 4 times a day whilst those with diabetes had to manage up to 4 insulin doses a day. The average out-of-pocket cost per person and the frequency of pharmacy visits at 6, 9 and 12 months post-transplantation remained relatively unchanged. Conclusion The medication regimen prescribed for kidney transplant recipients is complex and for most patients, it did not simplify over time post transplantation. Strategies are needed to support patients in managing the complexity of their medication regimen following kidney transplantation.

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Acknowledgements

We acknowledge the help of all personnel at the participating hospitals and community pharmacies.

Funding

This work was supported by the Australian National Health and Medical Research Council (NHMRC) Partnerships for Better Health Grant (APP1056717). First author was partially supported by the Faculty Graduate Research International Scholarship (FGRIS) from Monash University and a Monash Departmental Scholarship from Monash Nursing and Midwifery. During the period of writing the manuscript, first author was funded by a Postgraduate Publication Award from Monash University.

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Authors and Affiliations

  1. Monash Nursing and Midwifery, Monash University, 35 Rainforest Walk, Clayton Campus Wellington Road, Clayton, VIC, 3800, Australia

    Jac Kee Low, Kimberley Crawford & Allison Williams

  2. School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Deakin University, 221 Burwood Highway, Burwood, VIC, 3125, Australia

    Jac Kee Low & Elizabeth Manias

  3. Royal Melbourne Hospital, Parkville, Australia

    Elizabeth Manias

  4. Melbourne School of Health Sciences, University of Melbourne, Parkville, Australia

    Elizabeth Manias

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  1. Jac Kee Low
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  2. Kimberley Crawford
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Correspondence to Jac Kee Low.

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Low, J.K., Crawford, K., Manias, E. et al. Quantifying the medication burden of kidney transplant recipients in the first year post-transplantation. Int J Clin Pharm 40, 1242–1249 (2018). https://doi.org/10.1007/s11096-018-0678-9

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  • DOI: https://doi.org/10.1007/s11096-018-0678-9

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