Evaluating the contributors to treatment nonadherence in patients with kidney failure and adherence improvement strategies: implications for clinical practice

Kidney failure (KF) is an important chronic disease with immense global-health impact due to the excessive mortality, morbidity and treatment costs. Its highly complex therapy demands a high level of self-management, with strict dietary, fluid, dialysis and medication adherence. Nonadherence to all aspects of therapy is common, yet under-recognised. Strategies to improve treatment adherence in KF have not been widely implemented nor well established. This doctoral thesis, presented as a thesis by compilation, evaluates treatment adherence in KF patients. The overarching aim of the thesis was to explore the issues associated with nonadherence in patients with KF on dialysis, focusing on health literacy (HL), cognitive function and depression and analysing adherence improvement strategies. A combination of empirical studies and systematic and narrative literature reviews, using concepts from the WHO adherence framework, were undertaken to achieve these aims.