{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T03:02:45Z","timestamp":1787022165287,"version":"build-2736575974"},"reference-count":32,"publisher":"Public Library of Science (PLoS)","issue":"1","license":[{"start":{"date-parts":[[2025,1,24]],"date-time":"2025-01-24T00:00:00Z","timestamp":1737676800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"\n Background<\/jats:title>\n Patients with end-stage kidney disease often prefer home-based dialysis due to higher self-efficacy, which relates to improved medical treatment adherence. Kidney transplantation (KT) success depends on adhering to immunosuppressive medication post-transplant.<\/jats:p>\n <\/jats:sec>\n \n Objectives<\/jats:title>\n To investigate whether adherence post-kidney transplantation (KT) and patients\u2019 attitudes toward immunosuppression were influenced by their prior dialysis type modality. Additionally, the study examined if adherence and patient\u2019s attitudes towards immunosuppression are associated with kidney graft survival.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n This cross-sectional single-center study included 201 KT patients. Adherence was assessed using BAASIS and the coefficient of variation of calcineurin inhibitors (COV-CNI). Patient attitudes towards medication were evaluated using the Q-method. Pill burden, comorbidity score and HRQoL and medication complexity, were scored. Cox regression was applied to determine KT survival outcomes over a 14-year follow-up period (until Dec 2021).<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Prior dialysis modality was not associated with adherence to immunosuppression post-KT evaluated by BAASIS on average 4.7 years post-KT. Previous in-center hemodialysis patients had a higher CNI-COV (p = 0.011). The Q-sort analysis identified fully adherent patients linked to profile 1 (organized, resilient) whereas profile 2 patients were more careless. Patients linked to profile 3 (challenging, nervous) had higher education, a higher pill burden, and experienced more immunosuppression side effects. Death-censored graft loss increased by 7.6% with each additional pill, quadrupled if one dose of immunosuppression was missed, and increased by 2.9% for each point of COV-CNI rise.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Adherence to immunosuppression post-KT using BAASIS was not associated with prior dialysis type, despite in-center hemodialysis patients showing the highest COV-CNI. Taking COV-CNI into account, managing missed doses of immunosuppressants, and exploring patient attitudes could potentially enhance adherence and consequently improve KT survival.<\/jats:p>\n <\/jats:sec>","DOI":"10.1371\/journal.pone.0317435","type":"journal-article","created":{"date-parts":[[2025,1,24]],"date-time":"2025-01-24T13:52:07Z","timestamp":1737726727000},"page":"e0317435","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":4,"title":["Associations between dialysis modality and adherence to immunosuppression after kidney transplantation\u2014A single-center study"],"prefix":"10.1371","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0462-4833","authenticated-orcid":true,"given":"Fernanda","family":"Ortiz","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aino","family":"Salonsalmi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ilkka","family":"Helanter\u00e4","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2025,1,24]]},"reference":[{"issue":"3","key":"pone.0317435.ref001","doi-asserted-by":"crossref","first-page":"371","DOI":"10.1053\/j.ajkd.2017.09.014","article-title":"Hemodialysis Self-management Intervention Randomized Trial (HED-SMART): A Practical Low-Intensity Intervention to Improve Adherence and Clinical Markers in Patients Receiving Hemodialysis","volume":"71","author":"K Griva","year":"2018","journal-title":"Am J Kidney Dis"},{"key":"pone.0317435.ref002","doi-asserted-by":"crossref","first-page":"578","DOI":"10.1177\/0193945912439251","article-title":"Accuracy of measures of medication adherence in a cholesterol-lowering regimen","volume":"34","author":"J Dunbar-Jacob","year":"2012","journal-title":"West J Nurs Res"},{"key":"pone.0317435.ref003","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1186\/s12882-021-02464-1","article-title":"Health literacy level in a various nephrology population from Qu\u00e9bec: predialysis clinic, in-centre hemodialysis and home dialysis; a transversal monocentric observational study","volume":"22","author":"A Boyer","year":"2021","journal-title":"BMC Nephrol"},{"issue":"11","key":"pone.0317435.ref004","doi-asserted-by":"crossref","first-page":"1143","DOI":"10.1111\/tri.12394","article-title":"Health-related quality of life after kidney transplantation: who benefits the most?","volume":"27","author":"F Ortiz","year":"2014","journal-title":"Transpl Int"},{"issue":"3","key":"pone.0317435.ref005","first-page":"166","article-title":"Impact of patient education and knowledge on medication adherence in chronic kidney disease patients","volume":"19","author":"H. 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Aggarwal","year":"2018","journal-title":"Journal, Indian Academy of Clinical Medicine"},{"key":"pone.0317435.ref006","doi-asserted-by":"crossref","first-page":"2327","DOI":"10.1093\/ndt\/gfab232","article-title":"Mapping health-related quality of life after kidney transplantation by group comparisons: a systematic review","volume":"36","author":"Y Wang","year":"2021","journal-title":"Nephrol Dial Transplant"},{"key":"pone.0317435.ref007","doi-asserted-by":"crossref","first-page":"376","DOI":"10.1016\/j.transproceed.2010.12.015","article-title":"Assessment of health-related quality of life in renal transplant recipients and dialysis patients","volume":"43","author":"N Maglakelidze","year":"2011","journal-title":"Transplant Proc"},{"issue":"2","key":"pone.0317435.ref008","doi-asserted-by":"crossref","first-page":"388","DOI":"10.1111\/j.1600-6143.2011.03840.x","article-title":"Understanding the causes of kidney transplant failure: the dominant role of antibody-mediated rejection and nonadherence","volume":"12","author":"J Sellar\u00e9s","year":"2012","journal-title":"Am J Transplant"},{"key":"pone.0317435.ref009","doi-asserted-by":"crossref","first-page":"e18241","DOI":"10.1371\/journal.pone.0018241","article-title":"The Influence of Personality Traits on Reported Adherence to Medication in Individuals with Chronic Disease: An Epidemiological Study in West Sweden","volume":"6","author":"M Axelsson","year":"2011","journal-title":"PLOS ONE"},{"key":"pone.0317435.ref010","first-page":"655","article-title":"Personalidade e transplante. 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