Implementing a self-reported immunosuppression adherence questionnaire to screen for non-adherence in routine care of kidney transplant recipients.

INTRODUCTION: Self-reported measures of immunosuppression adherence have been largely examined in research settings. METHODS: In this single center study of 610 kidney transplant recipients, we examined if a voluntary, non-anonymous self-report measure could identify non-adherence in a routine clinic setting and how patients perceived such a measure. Non-adherence was measured using the Basel Assessment of Adherence to Immunosuppressive Medications Scale (BAASIS) and patient perception was elicited using a customized questionnaire. RESULTS: Non-responders to the survey (15%) were younger, more likely to be black, and less likely to have had a pre-emptive transplant. Among complete responders (n = 485), 38% reported non-adherence with non-adherent patients being younger (54 y vs. 60 y; p = .01), less likely to have been on dialysis pre-transplant (59% vs. 68%; p = .04), further out from transplant (37 vs. 22 months; p < .001) and had more rejections in the preceding year (8% vs. 3%; p = .02). Self-reported non-adherence was associated with higher calcineurin inhibitor intra-patient variability (27.4% vs. 24.5%; p = .02), but not with donor-specific antibody detection (27.8% vs. 21.2%, p = .15). Of patients providing feedback (n = 500), the majority of patients felt comfortable reporting adherence (92%), that the survey was relevant to their visit (71%), and that the survey did not interfere with their clinic visit (88%). CONCLUSION: In summary, a self-reported questionnaire during clinic visits identified immunosuppression non-adherence in a significant proportion of patients and was well received by patients. Integrating self-report measures into routine post-transplant care may enable early identification of non-adherence.

Bone turnover in preeclampsia-complicated pregnancy in North Indian women.

AIM: This prospective study aims to investigate the levels of bone turnover markers in pregnancy and correlate it with the assessment of preeclampsia. METHODS: A total of 140 women were followed up during their pregnancy. The women who developed preeclampsia (n=22), were compared with age-matched women (controls) who did not develop preeclampsia and had an uncomplicated pregnancy (n=22). Maternal serum levels of serum bone-specific alkaline phosphatase (sBAP), a marker of bone formation, and N-telopeptide of type 1 collagen (NTx), a marker of bone resorption, were estimated at recruitment (in the second trimester) and at delivery. sBAP and NTx levels were measured by enzyme immunoassay (EIA) and enzyme linked immunosorbent assay (ELISA), respectively. Serum and urinary calcium titers were compared by using a commercially-available calcium assay kit. RESULTS: Serum NTx levels increased significantly during pregnancy (P<0.02) and were significantly higher at delivery (P<0.01) in women with preeclampsia compared with controls. The levels of sBAP and serum calcium did not change significantly in both groups during pregnancy. There was no significant correlation between sBAP and NTx with maternal factors. A negative correlation was observed between sBAP and NTx levels in the preeclamptic group. CONCLUSIONS: Biochemical markers of bone turnover are greater in preeclampsia compared with normal pregnancy only when the disease is clinically evident (at delivery).