Mariana S Markell1, Sima Terebelo2. 1. Department of Medicine, Division of Renal Diseases Box 52, SUNY Downstate Medical Center, 450 Clarkson Ave, Brooklyn, NY, United States. Electronic address: mariana.markell@downstate.edu. 2. Department of Medicine, Division of Renal Diseases Box 52, SUNY Downstate Medical Center, 450 Clarkson Ave, Brooklyn, NY, United States.
Abstract
BACKGROUND: Complementary Medicine (CAM) is often used by patients with chronic illness and may not be disclosed to health care providers without prompting. In other populations, patients who use CAM were more likely to alter medications without discussing it with their provider. This study examined the relationship between self-reported use of CAM, attitudes toward care, and adherence to medical therapy in a population of inner-City kidney transplant recipients. METHODS: Cross-sectional observational analysis in a random convenience sample from the outpatient transplant clinic. Data were obtained via face-to-face structured closed-ended interview using validated survey instruments. RESULTS: 45% of patients reported using CAM. Of the study participants who used CAM, 39.1% reported non-adherence to immunosuppressant medications within the past three months, while among the non-CAM users, 17.9% reported non-adherence (p value=0.084). Adherence to hypoglycemic medication was significantly lower CAM users,(p=0.029). Patients who reported having somatic symptoms were more likely to use CAM. Symptom sum was significantly associated with CAM use, p=0.030, with 47.8% CAM users reporting skin problems vs. 10.7% non-CAM users,p=0.003 and 17.4% CAM users noting loss of appetite, compared to 3.5% of non-CAM users,p=0.002 In a random subgroup of 26 patients, 15% who did not use CAM reported medication side effects, while 53% of CAM users reported them, p =0.039. CONCLUSIONS: Use of CAM was common in our kidney transplant population. Patients who use CAM reported more somatic symptoms, more medication side effects and were more likely to be non-adherent to non-immunosuppressant medications. Positive response to questions about CAM use may be a surrogate marker for high symptom burden and risk of non-adherence to non-immunosuppresion medications in kidney transplant recipients.
BACKGROUND: Complementary Medicine (CAM) is often used by patients with chronic illness and may not be disclosed to health care providers without prompting. In other populations, patients who use CAM were more likely to alter medications without discussing it with their provider. This study examined the relationship between self-reported use of CAM, attitudes toward care, and adherence to medical therapy in a population of inner-City kidney transplant recipients. METHODS: Cross-sectional observational analysis in a random convenience sample from the outpatient transplant clinic. Data were obtained via face-to-face structured closed-ended interview using validated survey instruments. RESULTS: 45% of patients reported using CAM. Of the study participants who used CAM, 39.1% reported non-adherence to immunosuppressant medications within the past three months, while among the non-CAM users, 17.9% reported non-adherence (p value=0.084). Adherence to hypoglycemic medication was significantly lower CAM users,(p=0.029). Patients who reported having somatic symptoms were more likely to use CAM. Symptom sum was significantly associated with CAM use, p=0.030, with 47.8% CAM users reporting skin problems vs. 10.7% non-CAM users,p=0.003 and 17.4% CAM users noting loss of appetite, compared to 3.5% of non-CAM users,p=0.002 In a random subgroup of 26 patients, 15% who did not use CAM reported medication side effects, while 53% of CAM users reported them, p =0.039. CONCLUSIONS: Use of CAM was common in our kidney transplant population. Patients who use CAM reported more somatic symptoms, more medication side effects and were more likely to be non-adherent to non-immunosuppressant medications. Positive response to questions about CAM use may be a surrogate marker for high symptom burden and risk of non-adherence to non-immunosuppresion medications in kidney transplant recipients.