Treatment adherence and chronic kidney disease: Psychological aspects, contributing factors, and potential levers

Non-adherence to treatment affects 30% to 50% of patients with chronic diseases. It is associated with an increase in the frequency of acute complications and hospitalizations. In chronic kidney disease (CKD), non-adherence concerns drug treatment, diet, and lifestyle. It may affect up to 62% of hemodialysis patients and 28% of kidney transplant recipients. The long asymptomatic phase of CKD contrasts with a heavy medication burden—two factors that can hinder treatment adherence. In addition, the high prevalence of cognitive and depressive disorders, often underdiagnosed, is associated with the risk of non-adherence in CKD patients. Young age and social isolation have also been identified as risk factors. However, adherence is often difficult to assess. It may vary from one patient to the other, and in the same patient over the course of the disease. Non-adherence can sometimes reflect underlying psychological, personal, or social difficulties. Every health care professional involved in the care of CKD patients has a role to play in detecting poor adherence. In this general review, we discuss the psychological and medical aspects underlying non-adherence, as well as potential therapeutic levers.