Evaluation of Anxiety, Self-Management and Compliance with Immunosuppressive Therapy in Kidney Transplant Recipients

Year 2025, Volume: 15 Issue: 2, 135 - 144, 30.06.2025

Aziz Bulut , Aliye Bulut

https://doi.org/10.31832/smj.1610346

Abstract

Objective: The aim of this study was to evaluate anxiety, self-management and treatment adherence in kidney transplant recipients.
Materials and Methods: The participants consisted of 29 people who applied to the Organ Transplant Center at Gaziantep University between April and June 2023 and were voluntary to participate in the study.
Results: Severe anxiety was observed in all participants. The self-management of kidney transplant recipients had a direct correlation with early detecting and coping with abnormalities after kidney transplantation, self-care behavior in daily life and stress management, and finally self-monitoring. Also, their self-management had a direct correlation with early detecting and coping with abnormalities after kidney transplantation in terms of adherence to immunosuppressive therapy (p<0.001).
Conclusion: This study revealed that all participants suffered from severe anxiety and that kidney transplant recipients on immunosuppressive therapy lacked medication adherence and self-management.

Keywords

Kidney transplantation , Anxiety , Self-management , Immunosuppressive therapy adherence

Ethical Statement

Approval was obtained from the Non-Invasive Clinical Trials Ethics Committee of Gaziantep Islamic Science and Technology University and the participants were informed in accordance with the principles of the Declaration of Helsinki (2023/200). Permission was obtained from the authors, who conducted the validity and reliability study of the assessment tools.

Thanks

We are indebted to the participants for making this research possible and to all physicians and staff of the Organ Transplantation Centre of Gaziantep in Türkiye Research-Application Hospital of Gaziantep University.

References

• Smeltzer SC, Bare BG, Hinkle JL, Cheever KH. Brunner & Suddarth’s Textbook of Medical-Surgical Nursing. 12th ed. Wolters Kluwer Health/Lippincott Williams & Wilkins; 2010:1351-1356.
• Howard RJ, Cornell DL, Cochran L. History of deceased organ donation, transplantation, and organ procurement organizations. Prog Transplant. 2012;22(1):6-16.
• Garcia GG, Harden P, Chapman J. The global role of kidney transplantation. Kidney Blood Press Res. 2012;35:299–304. doi:10.1159/000337044
• Tonelli M, Wiebe N, Knoll G, Bello A, Browne S, Jadhav D, Klarenbach S, Gill J. Systematic review: kidney transplantation compared with dialysis in clinically relevant outcomes. Am J Transplant. 2011;11(10):2093–2109.
• Bayraktar S. Organ Transplantation and Psychological Life. Istanbul: Nobel Medical Bookstore; 2013.
• Köroğlu E. Psychiatry Textbook. Ankara: HYB Basım Yayın; 2012.
• Ding D. Post-kidney transplant rejection and infection complications. Nephrol Nurs J. 2010;37(4):419-426.
• Lin SY, Fetzer SJ, Lee PC, Chen CH. Predicting adherence to health care recommendations using health promotion behaviours in kidney transplant recipients within 1–5 years post-transplant. J Clin Nurs. 2011;20:3313–3321.
• Moore SM, Schiffman R, Waldrop-Valverde D, Redeker NS, McCloskey DJ, Kim MT, & ... Grady P. Recommendations of common data elements to advance the science of self-management of chronic conditions. J Nurs Scholarsh. 2016;48(5):437-447.
• Schäfer-Keller P, Dickenmann M, Berry DL, Steiger J, Bock A, De Geest S. Computerized patient education in kidney transplantation: Testing the content validity and usability of the Organ Transplant Information System (OTIS™). Patient Educ Couns. 2009;74(1):110-117.
• Lorig KR, Holman HR. Self-management education: history, definition, outcomes, and mechanisms. Ann Behav Med. 2003;26(1):1-7.
• Urstad KH. Patient Education for Renal Transplant Recipients. Doctoral Thesis, University of Oslo Faculty of Medicine; 2013.
• Titiz Mİ. Immunosuppression. In: Titiz Mİ, ed. Practical Approach to Renal Transplantation. Improved 3rd ed. Istanbul; 2010:105-131.
• KDIGO. http://www.kdigo.org. Accessed November 19, 2023.
• Gorevski E, Succop P, Sachdeva J, Cavanaugh TM, Volek P, Heaton P, & ... Martin-Boone JE. Is there an association between immunosuppressant therapy medication adherence and depression, quality of life, and personality traits in the kidney and liver transplant population? Patient Prefer Adherence. 2013;(7):301-307.
• Russell C, Ashbaugh C, Peace L, Cetingok M, Hamburger K, Owens S, & ... Wakefield M. Time-in-a-bottle (TIAB): A longitudinal, correlational study of patterns, potential predictors, and outcomes of immunosuppressive medication adherence in adult kidney transplant recipients. Clin Transplant. 2013;27(5):E580-E590.
• Güleç H, Sayar K, Özkorumak E. Somatic symptoms of depression. Turkish Psychiatry Journal. 2005;16:90–96.
• Kosaka S, Tanaka M, Sakai T, Tomikawa S, Yoshida K, Chikaraishi T, Keiko Kazuma K. Development of self-management scale for kidney transplant recipients, ıncluding management of post-transplantation chronic kidney disease. ISRN Transplantation. 2013;1-7.
• Çetin Ç. Böbrek nakli alicilarinda öz yönetim ölçeği geçerlik ve güvenirlik çalişmasi. Master's Thesis, Akdeniz University, Institute of Health Sciences; 2016. Antalya.
• Chisholm AM, Charles EL, Willamson MG, Mulloy LL. Development and Validatıon of The Immunosppressant Therapy Adherence Instrument (ITAS). Patient Educatıon and Counseling. 2004;59;13-50.
• Bayhan B. Organ nakli hastalarında immunsupresif tedaviye uyum ölçeğinin Türkiye’ de geçerlik ve güvenirliği. Master's Thesis. Dokuz Eylül University, Institute of Health Sciences; 2014. Izmir.
• Pizzuto D. Adherence program launched for kidney recipients and caregivers. The CANNT Journal. 2010;20(4):13.
• Kobus G, Małyszko J, Małyszko JS, Puza E, Bachorzewska-Gajewska H, Mysliwiec M. Compliance with lifestyle recommendations in kidney allograft recipients. Transplant Proc. 2011;43(8):2930–2934.
• Ayar Y, Ersoy A, Sayılar EI, Yılmaz A, Yadın MF. Evaluation of depression, anxiety and life quality in kidney transplant recipients. Turkish Nephrology, Dialysis and Transplantation Journal. 2015;24(1):98-105.
• Kaçmaz N, Ünsal Barlas G. The psychsocial status of liver transplant patient and their relatives on the effect of quality of life. Journal of Psychiatric Nursing. 2014;5(1):1-8.
• Özsaker, E. Transplantation and quality of life. Balıkesir Health Sciences Journal. 2014;3(3):166-173.
• Chang Y, Lai Y, Po-Huang RN, Lee MD, Tsai M, Shun RN. Unmet care needs and related factors of spouses of liver or kidney transplant recipients. Clinical Nursing Research. 2021;30(7):1038–1046.
• Hennemann K, Bauer-Hohmann M, Klewitz F, et al. Organ integration in kidney transplant patients—results of a KTx360° substudy. J Psychosom Res. 2021;145:110464.
• Temiz G, Kaya A. Psychosocial problems and nursing approach to volume after kidney transplantation. Türk Nefroloji, Diyaliz ve Transplantasyon Hemşireleri Derneği Nefroloji Hemşireliği Dergisi. 2017;12(2):1-6.
• Lai YL, Neo HLM, Vathsala A, Griva K. Comparing emotional adjustment of living-donor and deceased-donor kidney transplant patients. Transplantation Direct. 2020;6(2):1-6.
• Czyżewski Ł, Frelik P, Wyzgał J, Szarpak Ł. Evaluation of the quality of life, severity of depression, anxiety and stress in patients after kidney transplantation. Transplantation Proceedings. 2018;50(6):1733-1737.
• Lorenz EC, Smith BH, Cosio FG, et al. Long-term immunosuppression adherence after kidney transplant and relationship to allograft histology. Transplant Direct. 2018;4(10):e392.
• Nevins TE, Thomas W. Quantitative patterns of azathioprine adherence after renal transplantation. Transplantation. 2009;87(5):711-8.
• Calia R, Lai C, Aceto P, Luciani M, Camardese G, Lai S, et al. Attachment style predict compliance, quality of life and renal function in adult patients after kidney transplant: Preliminary results. Renal Failure. 2015;37(4):678-680.
• Haspeslagh A, De Bondt K, Kuypers D, Naesens M, Breunig C, Dobbels F. Completeness and satisfaction with the education and information received by patients immediately after kidney transplant: a mixed-models study. Progress Prog Transplant. 2013;23(1):12-22.
• Weng LC, Dai YT, Huang HL, Chiang YJ. Self-efficacy, self-care behaviours and quality of life of kidney transplant recipients. J Adv Nurs. 2009;66(4):828–838.
• Scheel J, Reber S, Stoessel L,Waldmann E, Jank S, Eckardt KU, et al. Patient-reported non-adherence and immunosuppressant trough levels are associated with rejection after renal transplantation. BMC Nephrology. 2017;18:107.