Supporting Adherence and Self-management

Children with chronic kidney disease (CKD) and kidney transplant recipients are often prescribed various medications, lifestyle changes, and/or other treatments to manage symptoms and prevent disease progression. Persistent adherence to these treatments can be challenging for children and their families due to several complex factors. Nonadherence can lead to significant issues with CKD, including rapid disease progression, impact on other organs and systems, or loss of graft in transplant patients. There are evidence-based interventions to improve adherence that can be delivered by behavioral specialists or by medical teams at the point of care. Interventions include problem-solving around adherence barriers, setting up reminder systems, changing a medication formulation or regimen, or providing guidance on pill swallowing. This chapter discusses in detail the barriers to adherence and strategies to assess and address them.