Adherence and illness perceptions in patients with CKD and ESRD

The management of end-stage renal disease (ESRD) is complex and necessitates significant self-management behaviors, including treatment adherence, which are often stressful and challenging for patients. Estimates of adherence to the various aspects of ESRD management vary as a product of the behavior under investigation (such as taking medicines, dietary restrictions, or dialysis attendance) and the heterogeneity of assessment methods employed. Despite this, nonadherence is a common problem that is associated with adverse clinical outcomes. Patient-, disease-, and treatment-related factors are all associated with nonadherence in ESRD patients. Psychosocial factors including mood, self-efficacy, social support, illness, and treatment perceptions have all been shown to be particularly important predictors of adherence and may be amenable to intervention. There is emerging evidence showing the benefits of psychosocial interventions for supporting adherence. Identifying ESRD patients who show problematic adherence and establishing the most effective interventions designed to better support adherence require further research informed by theory. Ultimately, understanding how to best implement evidence-based interventions to support adherence as part of routine ESRD care is critical if we are to improve patient and clinical outcomes.