الملخص
Abstract Objective: to evaluate the use of a renal health application by kidney transplant recipients. Method: a retrospective, observational study with a sample composed of individuals registered in the kidney transplant section of the application from July of 2018 to April of 2021. Demographic data, data entry, time of use, weight, blood pressure, blood glucose, creatinine, medication schedules, appointments, and tests were the variables collected. Descriptive analysis of the data was performed. Results: eight hundred and twenty-three downloads of the application were identified, and 12.3% of those were registered as kidney transplant recipients, the majority from southeastern Brazil (44.9%), 36±11 years old, and female (59.1%). Of the sample, 35.1% entered information such as creatinine (62%), weight (58.2%), and blood pressure (51.8%). Most used the application for one day (63.3%) and 13.9% for more than one hundred days. Those who used it for more than one day (36.7%) recorded weight (69%), medication intake (65.5%) and creatinine (62%), and scheduled appointments (69%). Conclusion: the kidney transplant recipient section of the Renal Health application generated interest in the young population, but showed low adherence throughout the assessed months. These results offer a relevant perspective on the implementation of mHealth technologies in kidney transplantation.
Resumo Objetivo: avaliar o uso do aplicativo Renal Health por transplantados renais. Método: estudo observacional retrospectivo com amostra composta por usuários que realizaram cadastro na seção para transplantados renais do aplicativo de julho de 2018 a abril de 2021. Foram coletadas as seguintes variáveis: dados demográficos, inserção de dados, tempo de uso, registros de peso, pressão arterial, glicemia, creatinina, horários das medicações, consultas e exames. Realizou-se análise descritiva dos dados. Resultados: houve 1.823 downloads do aplicativo e 12,3% cadastraram-se na seção para transplantados renais, a maioria do Sudeste do Brasil (44,9%), com 36±11 anos e do sexo feminino (59,1%). Da amostra, 35,1% inseriram informações como creatinina (62%), peso (58,2%) e pressão arterial (51,8%). A maioria utilizou o aplicativo por um dia (63,3%) e 13,9% por mais de cem dias. Os que utilizaram por mais de um dia (36,7%), inseriram peso (69%), agendaram consultas (69%), medicações (65,5%) e creatinina (62%). Conclusão: a seção para transplantados renais do aplicativo Renal Health despertou interesse na população jovem, mas apresentou baixa adesão ao longo dos meses avaliados. Esses resultados oferecem perspectiva relevante na implementação de tecnologias mHealth no transplante renal.
Resumen Objetivo: evaluar el uso de la aplicación Renal Health por parte de los receptores de trasplante renal. Método: estudio observacional retrospectivo con una muestra compuesta por usuarios que se registraron en la sección de trasplantados renales dentro de la aplicación desde julio de 2018 hasta abril de 2021. Se recolectaron las siguientes variables: datos demográficos, ingreso de datos, tiempo de uso, registros de peso, presión arterial, glucosa en sangre, creatinina, esquemas de medicación, consultas y exámenes. Se realizó un análisis descriptivo de los datos. Resultados: Ocurrieron 1.823 descargas de la aplicación y 12,3% se registró en la sección de trasplantados, la mayoría del sudeste de Brasil (44,9%), con edad de 36±11 años y del sexo femenino (59,1%). De la muestra, 35,1% ingresó información como: creatinina (62%), peso (58,2%) y presión arterial (51,8%). La mayoría utilizó la aplicación durante un día (63,3%) y el 13,9% más de cien días. Quienes lo usaron por más de un día (36,7%), agregaron peso (69%), programación de consultas (69%), medicación (65,5%) y creatinina (62%). Conclusión: la sección para trasplantados renales de la aplicación Renal Health despertó interés en la población joven, pero mostró baja adherencia en los meses evaluados. Estos resultados ofrecen una perspectiva relevante en la implementación de tecnologías mHealth en el trasplante renal.
الموضوعات
Humans , Patient Education as Topic , Kidney Transplantation/education , Kidney Transplantation/rehabilitation , Nephrology Nursing , Mobile Applicationsالملخص
ABSTRACT BACKGROUND: Epidemiological studies involving large samples usually face financial and operational challenges. OBJECTIVES: To describe the planning and execution of ADHERE Brazil, an epidemiological study on 1,105 kidney transplant patients, and report on how the study was structured, difficulties faced and solutions found. DESIGN AND SETTING: Cross-sectional multicenter study in 20 Brazilian kidney transplantation centers. METHODS: Actions developed in each phase of implementation were described, with emphasis on innovations used within the logistics of this study, aimed at estimating the prevalence of nonadherence to treatment. RESULTS: Coordination of activities was divided into four areas: general, regulatory, data collection and statistics. Weekly meetings were held for action planning. The general coordination team was in charge of project elaboration, choice of participating centers, definition of publication policy and monitoring other coordination teams. The regulatory team provided support to centers for submitting the project to ethics committees. The data collection team prepared a manual on the electronic collection system, scheduled web meetings and was available to respond to queries. It also monitored the data quality and reported any inadequacies found. Communication with the centers was through monthly reports via e-mail and distribution of exclusive material. The statistical team acted in all phases of the study, especially in creating the data analysis plan and data bank, generation of randomization lists and data extraction. CONCLUSIONS: Through these logistics, we collected high-quality data and built a local research infrastructure for further studies. We present supporting alternatives for conducting similar studies. CLINICAL TRIAL ANNOTATION: http://clinicaltrials.gov/ on October 10, 2013; NCT02066935.
الموضوعات
Humans , Kidney Transplantation , Brazil/epidemiology , Prevalence , Cross-Sectional Studies , Communicationالملخص
Resumo Objetivo: investigar crenças sobre o transplante renal em pacientes submetidos a esse procedimento cirúrgico. Método: pesquisa qualitativa, realizada com 34 pacientes. A elaboração da entrevista e a discussão dos resultados foram realizadas a partir do Modelo de Crenças em Saúde e os dados organizados de acordo com a Análise de Conteúdo. Resultados: amostra com média de idade de 45,94 (±10,67) anos, mediana de tempo de transplante de 13 anos, sendo 55,9% masculina. Discussão: observou-se predominância das crenças relacionadas aos benefícios percebidos na realização do transplante renal em comparação às dificuldades percebidas; as crenças sobre motivação pela escolha do transplante e motivação para o tratamento estavam associadas às crenças sobre o transplante renal e às crenças relativas aos benefícios percebidos.
Abstract Objective: to investigate beliefs about kidney transplantation in transplanted patients. Method: qualitative research with 34 participants. The elaboration of the interview and discussion of the results were based on the theory of the Health Belief Model and the data was organized according to the Content Analysis. Results: A mean age of 45.94 (± 10.67) years, median transplant time of 13 years, being 55.9% of men. Discussion: we observed a predominance of beliefs related to perceived benefits in renal transplantation compared to perceived difficulties; and beliefs about motivation for choosing a transplant and motivation for treatment were associated with beliefs about kidney transplantation and beliefs perceived benefits.
الملخص
Abstract Introduction: Multidisciplinary clinics are the best approach towards Chronic Kidney Disease (CKD) patients in pre-dialysis phases. The few studies regarding kidney transplant recipients (KTR) compare multidisciplinary and non-multidisciplinary clinics. Methods: In this study, we compared the quality of multidisciplinary CKD care between 101 KTR and 101 propensity score-matched non-transplant pre-dialysis patients (PDP). Prevalence of patients without specific treatment at any time and percent time without specific treatment for CKD complications were the main outcomes and patient and kidney function survival, glomerular filtration rate (GFR) decline, prevalence of CKD-related complications, and percent time within therapeutic goals were the exploratory ones. Results: Time within most goals was similar between the groups, except for diastolic blood pressure (83.4 vs. 77.3%, RR 0.92, CI 0.88-0.97, p = 0.002) and hypertriglyceridemia (67.7 vs. 58.2%, OR 0.85, CI 0.78-0.93, p < 0.001), better in non-transplant PDP, and for proteinuria (92.7 vs. 83.5%, RR 1.1, CI 1.05-1.16, p < 0.001), better in KTR. Patient survival and GFR decline were similar between the groups, although non-transplant PDP tended to progress earlier to dialysis (9.9% vs. 6.9%, HR 0.39, p = 0.07, CI 0.14-1.08). Discussion: The similar findings between non-transplant PDP and KTR suggests that good and comparable quality of multidisciplinary is a valid strategy for promoting optimal clinical management of CKD-related complications in KTR.
Resumo Introdução: Clínicas multidisciplinares são a melhor abordagem para pacientes com doença renal crônica (DRC) em fases pré-dialíticas. Os poucos estudos sobre receptores de transplante renal (RTR) comparam clínicas multidisciplinares e não multidisciplinares. Métodos: Neste estudo, comparamos a qualidade do atendimento multidisciplinar para DRC entre 101 RTR e 101 pacientes pré-dialíticos (PPD) não transplantados pareados com escore de propensão. A prevalência de pacientes sem tratamento específico em qualquer momento e a porcentagem de tempo sem tratamento específico para complicações de DRC foram nossos desfechos principais, e a sobrevida do paciente e da função renal, declínio da taxa de filtração glomerular (TFG), prevalência de complicações relacionadas à DRC e porcentagem de tempo dentro dos objetivos terapêuticos foram os exploratórios. Resultados: O tempo no alvo para a maioria dos objetivos foi semelhante entre os grupos, exceto para a pressão arterial diastólica (83,4 vs. 77,3%, RR 0,92, IC 0,88-0,97, p = 0,002) e hipertrigliceridemia (67. 7 vs. 58,2%, OR 0,85, IC 0,78-0,93, p < 0,001), melhor em PPD não transplantados, e para proteinúria (92,7 vs. 83,5%, RR 1,1, IC 1,05-1,16, p < 0,001), melhor em RTR. A sobrevida do paciente e o declínio da TFG foram semelhantes entre os grupos, embora PPD não transplantados tendessem a progredir mais cedo para a diálise (9,9% vs. 6,9%, HR 0,39, p = 0,07, IC 0,14-1,08). Discussão: Os resultados semelhantes entre PPD não transplantados e os RTR sugerem que a qualidade multidisciplinar boa e comparável é uma estratégia válida para promover a gestão clínica ideal de complicações relacionadas à DRC em RTR.
الملخص
ABSTRACT OBJECTIVE To estimate the prevalence and variability of nonadherence to immunosuppressives and nonpharmacological treatment across kidney transplantation centers and two health access-disparate regions in Brazil. METHODS In a cross-sectional design, a random multistage sample of 1,105 patients was included, based on center transplantation activity (low/moderate/high) and region (R1: North/Northeast/Mid-West; and R2: South/Southeast). Nonadherence to immunosuppressives (implementation phase) was assessed using the Basel Assessment of Adherence to Immunosuppressive Medications Scale (BAASIS)©. Self-report questionnaires assessed nonadherence to physical activity, smoking cessation, alcohol intake, and appointment keeping. We compared regions using the adjusted-χ2 or t-test. RESULTS Most patients were men (58.5%), white (51.4%), and had a mean age of 47.5 (SD = 12.6) years. Regarding kidney transplantation centers, 75.9% were from R2 and 38.2% had low activity. The patients in R2 were older, white-majority, had more frequently steady partners, and received peritoneal dialysis. Nonadherence to immunosuppressives ranged from 11-65.2%; 44.5-90% to physical activity; 0-23.7% to appointment keeping; and 0-14% to smoking cessation. The total prevalence of nonadherence and by region (R1 versus R2) were: for immunosuppressives, 39.7% (44.9% versus 38.1%, p = 0.18); for smoking, 3.9% (1% versus 5%, p < 0.001); for physical activity, 69.1% (71% versus 69%, p = 0.48); for appointment keeping, 13% (12.7% versus 12%, p = 0.77); and for alcohol consumption, 0%. CONCLUSION Despite differences among centers and high variability, only the nonadherence to smoking cessation was higher in the region with greater access to kidney transplantation. We suppose that differences in healthcare access may have been overcome by other positive aspects of the post kidney transplantation treatment.
الموضوعات
Humans , Male , Female , Kidney Transplantation , Brazil , Cross-Sectional Studies , Medication Adherence , Immunosuppressive Agents/therapeutic use , Middle Agedالملخص
ABSTRACT CONTEXT AND OBJECTIVE : Adherence to medication is a key issue relating to outcomes from transplantation and it is influenced by several factors, such as stress and coping strategies. However, these factors have been poorly explored. We aimed to compare stress and coping strategies between adherent and nonadherent renal transplant recipients who were receiving immunosuppression. DESIGN AND SETTING : We conducted a comparative, cross-sectional and observational study at a university-based transplantation clinic in Juiz de Fora, Brazil. METHODS :Fifty patients were recruited and classified as adherent or nonadherent following administration of the Basel Assessment of Adherence to Immunosuppressive Medications Scale. Stress was evaluated using the Lipp Stress Symptom Inventory for Adults and coping strategies were assessed using the Ways of Coping Scale. RESULTS : The study included 25 nonadherent patients and 25 controls with a mean age of 44.1 ± 12.8 years and median post-transplantation time of 71.8 months. Stress was present in 50% of the patients. Through simple logistic regression, nonadherence was correlated with palliative coping (OR 3.4; CI: 1.02-11.47; P < 0.05) and had a marginal trend toward significance with more advanced phases of stress (OR 4.7; CI: 0.99-22.51; P = 0.053). CONCLUSION :Stress and coping strategies may have implications for understanding and managing nonadherent behavior among transplantation patients and should be considered among the strategies for reducing nonadherence.
RESUMO CONTEXTO E OBJETIVO :Aderência à medicação é uma questão chave para o resultado do transplante e é influenciada por diversos fatores, tais como o estresse e estratégias de enfrentamento ou coping . Entretanto, esses aspectos têm sido pouco explorados. Compararmos o estresse e as estratégias de coping em paciente transplantados renais, aderentes e não aderentes, em uso de imunossupressores. TIPO DE ESTUDOE LOCAL : Realizamos estudo comparativo, transversal e observacional em uma clínica universitária de transplantes em Juiz de Fora, Brasil. MÉTODO :Cinquenta pacientes foram selecionados e classificados como aderentes e não aderentes a partir da escala Basel Assessment of Adherence to Immunosuppressive Medications Scale. O estresse foi avaliado pelo Inventário de Sintomas de Estresse para Adulto de Lipp e as estratégias de coping foram avaliadas pela escala Escala de Modos de Enfrentamento de Problemas. RESULTADOS : O estudo inclui 25 pacientes não aderentes e 25 controles com idade média de 44,1 ± 12,8 anos e mediana de tempo de transplante de 71,8 meses. Estresse esteve presente em 50% dos pacientes. Por regressão linear simples, a não aderência foi associada com o coping paliativo (OR 3,4, CI: 1,02-11,47; P < 0,05) e teve uma tendência marginal a significância com as fases mais avançadas do estresse (OR 4,7, CI: 0,99-22,51; P = 0,053). CONCLUSÃO : Estresse e estratégias de coping podem trazer implicações na compreensão e manejo do comportamento de não aderência dos pacientes transplantados e deveriam ser considerados nas estratégias na redução da não aderência.
الموضوعات
Humans , Male , Female , Adult , Middle Aged , Stress, Psychological , Adaptation, Psychological , Kidney Transplantation/psychology , Medication Adherence/psychology , Immunosuppressive Agents/therapeutic use , Palliative Care/psychology , Logistic Models , Cross-Sectional Studies , Treatment Refusal/psychology , Statistics, Nonparametric , Educational Status , Medication Adherence/statistics & numerical data , Self Report , Behavior Rating Scaleالملخص
to identify the main gains and stressors perceived by the patient, one year subsequent to kidney transplantation. a qualitative study, in which the data were obtained and analyzed through the Discourse of the Collective Subject and frequency counting, with the participation of 50 patients who had received kidney transplantation. the sample presented a mean age of 44±12.8 years old, and a predominance of males (62%). The principal positive changes provided by the transplant were: return to activities; freedom/independence; well-being and health; strengthening of the I; and closening of interpersonal relationships. The most-cited stressors were: fear; medication; excess of care/control; specific characteristics of the treatment; and failure to return to the social roles. kidney transplantation caused various positive changes in the patient's routine, with the return to activities of daily living being the most important gain, in the participants' opinion. In relation to the stressors, fear related to loss of the graft, and questions relating to the immunosuppressive medication were the main challenges to be faced following transplantation.
identificar os principais ganhos e estressores percebidos pelo paciente, após um ano de transplante renal. trata-se de um estudo qualitativo, em que os dados foram obtidos e analisados através do Discurso do Sujeito Coletivo e contagem de frequência, com a participação de 50 pacientes transplantados renais. a amostra apresentou média de idade de 44±12,8 anos e predominância do sexo masculino (62%). As principais mudanças positivas proporcionadas pelo transplante foram: retorno às atividades; liberdade/independência; bem-estar e saúde; fortalecimento do eu; e estreitamento das relações interpessoais. Os estressores mais citados foram: medo; medicação; excesso de cuidado/controle; particularidades do tratamento; e não retorno aos papéis sociais. o transplante renal proporcionou várias mudanças positivas à rotina do paciente, sendo o retorno às atividades de vida diária o ganho mais importante, na opinião dos participantes. Quanto aos estressores, o medo relacionado à perda do enxerto e questões relativas ao medicamento imunossupressor foram os principais desafios a serem enfrentados após o transplante.
identificar las principales ganancias y estresores percibidos por el paciente, después de un año de trasplante renal. se trata de un estudio cualitativo, en que los datos fueron obtenidos y analizados a través del Discurso del Sujeto Colectivo y conteo de frecuencia, con la participación de 50 pacientes trasplantados renales. la muestra presentó promedio de edad de 44±12,8 años y predominancia del sexo masculino (62%). Los principales cambios positivos proporcionadas por el trasplante fueron: retorno a las actividades; libertad/independencia; bienestar y salud; fortalecimiento del yo; y estrechamiento de las relaciones interpersonales. Los estresores más citados fueron: miedo; medicación; exceso de cuidado/control; particularidades del tratamiento; y no retorno a los papeles sociales. el trasplante renal proporcionó varios cambios positivos en la rutina del paciente, siendo el retorno a las actividades de la vida diaria la ganancia más importante, en la opinión de los participantes. En cuanto a los estresores, el miedo relacionado a la pérdida del injerto y las cuestiones relativas al medicamento inmunosupresor fueron los principales desafíos a ser enfrentados después del trasplante.