Evaluation of the Simplified Medication Adherence Questionnaire Score in Detecting Noncompliance and Nonadherence in Live-Related Kidney Transplantation

Background: Non-adherence to immunosuppressive medication is negatively linked to poor clinical outcomes in kidney transplant recipients (KTRs). This study aimed to assess the validation of the Simplified Medication Adherence Questionnaire (SMAQ) in non-adherence/noncompliance in KTRs. Methods: A Prospective study selected 77 live-related KTRs from 190 KTRs from Ain Shams University Transplant Unit. All patients were subjected to SMAQ and pill count (PC) after analysis; KTRs were divided into compliant/adherent (N=23)(PC>95%, SMAQ Score 0), compliant/non-adherent (N=35)(PC>95%, SMAQ Score>1) and non-compliant/non-adherent (N=19)(PC<95%, SMAQ Score>1). Laboratory work and drug levels were assessed monthly during study period. Results: The prevalence of non-adherence was 70.12%(54 KTRs), low PC within safety margin (95-80% PC) was 23.37%(18 KTRs) and PC below 80% was 1.29%(1 KTRs). SMAQ could predict non-compliance/non-adherence for Calcineurin inhibitor (CNI), Mycophenolate mofetil (MMF), and steroids with AUC 0.715, 0.708, and 0.779 respectively. The SMAQ sensitivity in MMF, and steroids 84.2% and 89.5% respectively while specificity in CNI 91.4%. The logistic regression analysis for predictors of non-adherence: SMAQ scores for CNI, MMF and steroids was significant (p-value<0.05). SMAQ score was negatively correlated with PC in CNI, MMF, and steroid p-value<0.001. The causes related to non-adherence were routine and forgetfulness for CNI and steroid while for MMF drug adverse effect was 36.8%(7 KTRs), and pregnancy within one-year post-transplant for CNI, MMF, and steroid p-values 0.022, 0.043, and 0.026 respectively. There were no significant differences between groups in the type of rejection, serum creatinine at 3 months, and at 1-year. Conclusion: SMAQ could be used in the prediction and screening of noncompliance/non-adherence. Patients were counseled to avoid this behavior. A longer duration is needed for assessment of impact of noncompliance/non-adherence on outcomes.