Please select the eligibility criteria that correspond to the clinical trial below.
Title: Adherence Enhancement for Renal Transplant Patients
Brief Summary: Despite significant advances in the care of kidney transplant recipients, long term graft survival after renal transplantation remains suboptimal. Medication nonadherence and clinical inertia are key contributors to graft loss. The purpose of the proposed RCT feasibility study is to evaluate impact of a "bundled" wireless real time medication reminder system and blood pressure monitoring system in combination with a cognitive behavioral adherence skills enhancement program upon medication adherence, therapeutic drug concentration, and blood pressure, in nonadherent kidney transplant recipients with hypertension. We propose to recruit 60 kidney transplant recipients in phase 1 with 20 non-adherent continuing to phase 2 for a 5-month feasibility RCT.


Options:
A: Inclusion Criteria:

* Persons \> 21 years of age
* first time recipient of a solitary kidney transplant
* prescribed at least 3 medications for immunosuppression and hypertension
* previous history of non-adherence
* functioning kidney transplant
* ability to speak, hear and understand English
* able to use medication delivery device and self administer medications
* able to operate blood pressure monitor
* comfortable using cell phone
* no other diagnosis that might shorten lifespan
* transplant physician's assent that the patient can participate

Exclusion Criteria:

* failure to meet all inclusion criteria
B: Inclusion Criteria:

* Most recent phosphorus and mean phosphorus over last 3 months \> 5.5 mg/dL
* Age ≥ 18 years
* On chronic hemodialysis ≥ 6 months
* English speaking

Exclusion Criteria:

* Mentally incompetent
* AIDS
* Cancer
* Terminal illness
* Pregnancy
* Nursing home residence
* No telephone access
* In another phosphorus related study
* Unable to identify written words
C: Inclusion Criteria:

* Our target population is male and female hemodialysis patients age 18 years or greater who are English speakers.

Exclusion Criteria:

* We will exclude children because they comprise a minority of the dialysis population and their enrollment would require an adult decision maker's consent.
* We will exclude patients who are significantly cognitively impaired and hence, unable to comprehend study surveys.
* Cognitive function will be assessed at baseline using the mini-Cog, a validated measure of cognitive capacity that we have used previously, and patients with scores \<3 will be excluded.
* Based on our prior studies, we estimate that approximately 5% of patients will be excluded based on this criterion.
* Similarly, non-English speakers will be excluded.
* Finally, patients undergoing active work-up for living donor kidney transplant, and/or considering transfer to peritoneal dialysis will be excluded as they are less likely to remain on hemodialysis for the duration of the study.
D: Inclusion Criteria:

* Individuals with end stage renal disease (ESRD) who are 18 years of age or older,
* Individuals who are literate,
* Community-dwelling adults who have been receiving maintenance dialysis for at least 3 months.

Exclusion Criteria:

* Individuals who cannot read or write,
* Individuals who do not speak English,
* Individuals who plan to move out of the area or change dialysis centers within the next 6 months,
* Individuals who have a life expectancy of less than 12 months,
* Individuals who are scheduled for a living donor transplant,
* Individuals who cannot see the PDA screen or use the stylus to make food selections from the PDA screen, or
* Individuals who live in an institutional setting in which they would have limited control over their dietary intake.

Answer: A