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.