Conclusions
eHealth interventions can improve medication adherence in kidney transplantation in the short time. However more high-quality intervention studies need performing to determine whether eHealth improves long-term adherence and clinically relevant outcomes.
Keywords: eHealth; kidney transplant; medication adherence; telemedicine.
Introduction
The end-stage renal disease (ESRD) is a significant public health issue in the worldwide. The number of ESRD patients with need for the renal replacement therapy is estimated between 4.902 and 7.083 million(1 ). Moreover, there is a growing trend(2 ). In the United States, spending for ESRD patients totaled $35.9 billion, accounting for 7.2% of the overall Medicare paid claims in the fee-for-service system, and the share has remained relatively constant for a decade(3 , 4 ).
Kidney transplantation (KTx) is the optimal therapy for ESRD. Compared to dialysis treatment, KTx is associated with a better psychosocial function, improved quality of life as well as lower costs and mortality (5 ,6 ). Although short-term outcomes after KTx are excellent, with a 96%-98%(7 ) 1-year graft survival, long-term outcomes remain suboptimal, the 10-year graft survival remains low (67.8%) (8 ). A key reason for the lack of improvement in long-term outcomes is poor adherence to immunotherapy regimen. As immunosuppressive therapy is often critical for KTx, they need to take immunosuppressants for life to prevent rejection. Unfortunately, findings from several studies have indicated that in solid organ transplant recipients, The highest rate of immunosuppressant non-adherence was found in KTx with a prevalence of 36-55% (9 ). This low adherence may be due in part to complicated treatment regimens, not only due to the number of pills required, but also to frequent dose adjustments based on blood level monitoring, side effects and rejection episodes (10 ). Additional barriers such as financial problems (11 ), memory issues (12 ), and communication barriers (13 ).
New eHealth technologies offer potential solutions for improving medication adherence in KTx. The World Health Organization (WHO) broadly defines eHealth as the use of information and communication technologies (ICT) for health, including patient treatment, research, education of healthcare professionals, and public health monitoring (14 ). Currently, with the rapid development of ICTs, eHealth interventions appear to be a useful tool for increasing medication adherence. The benefits of eHealth are widely acknowledged. It can contribute to achieving universal health coverage by overcoming geographical barriers, increasing access, and the provision of health services to remote populations and underserved communities (15 ).
Previous meta-analyses describing the effect of eHealth intervention on the medication adherence of solid organ transplant patients have been published. Tang et al.’s (16 ) meta-analysis suggests that eHealth interventions may improve medication adherence in the short term. On the contrary, Lee et al.’s (17 ) meta-analysis showed that the effects of the eHealth interventions were similar to those of the care provided to the control group. In addition, medication adherence varies widely among different types of transplant patients. Therefore, it is necessary to systematically evaluate whether eHealth interventions can improve medication compliance in KTx.