In chronic kidney disease (CKD), medication adherence depends on coordinated, interdisciplinary care that helps patients manage complex regimens, avoid preventable errors, and improve long-term outcomes.
Medication adherence is central to CKD care. Like many people living with chronic illness, patients with CKD often manage multiple conditions and medications, making treatment across specialties difficult to coordinate. That burden often falls on patients and caregivers, who must follow complicated treatment plans and reconcile guidance from multiple clinicians. Interdisciplinary coordination between nephrologists, primary care providers, pharmacists, dieticians, and everyone who interacts with patients is therefore essential to ensure patient education, improve adherence, and reduce medication errors.
Why medication management in CKD breaks down so easily
Diabetes, cardiovascular disease, and hypertension commonly coexist with CKD, and each condition may require additional medications to control symptoms, such as ACE inhibitors or ARBs, SGLT2 inhibitors, and MRAs to manage blood pressure, control blood sugar, and reduce protein in the urine. These therapies can add up to 12 medications a day in addition to any vitamins or supplements a patient is also taking.
Patients must be cautious of each medication’s side effects and be aware that certain combinations may lead to adverse effects. For example, some pain medications, including nonsteroidal anti-inflammatory drugs (NSAIDs), can directly harm the kidneys. On the other hand, many antibiotics, oral diabetes medications, and some heart medications that are eliminated by the kidneys may accumulate to toxic levels as kidney function declines and cause complications. Other drugs can disrupt electrolytes such as sodium and potassium, increasing the risk of seizures or heart rhythm problems. What may seem like a harmless over-the-counter medication or supplement may result in serious health issues.
Managing many prescriptions can also be a lot for patients to handle, with various dosing timings, administration methods, and instructions causing self-administration complexity and increased risk of errors. For example, some medications must be taken with food as they can cause nausea if taken with an empty stomach, while others require specific spacing to maintain consistent absorption levels in the bloodstream. Keeping track of these nuances can be difficult for patients, and a lack of proper adherence can impact health outcomes.
Pharmacy coordination improves overall chronic disease care management
Increased patient education and stronger health literacy are associated with better medication understanding and can support improved treatment adherence. When care teams as a whole are more involved in a patient’s care, it can improve these outcomes. A recent review found that pharmacist-led interventions improved medication adherence in most included studies of patients with multimorbidity. Additionally, CDC-reviewed telehealth evidence suggests that tools such as live video, text messaging, web-based content, and interactive platforms are effective and important methods to support medication adherence in chronic disease care.
On the contrary, when care is fragmented, providers may miss how conditions and treatments interact or whether the overall plan is improving outcomes over time. It is important for providers across the care continuum – nephrologists, endocrinologists, specialty pharmacists, renal dieticians, and mental health providers – to check in with patients and peers regarding ongoing medications plans. While these plans require collective input, they also need follow-up appointments and medication reassessment throughout care. As CKD patients receive blood tests up to every one to three months, changes in kidney filtration, urinary protein, and mineral imbalances can suggest whether a given therapy is working or whether providers should consider making adjustments.
Keeping patients at the center of care as CKD treatments evolve
While kidney health is shaped by many factors, including diet, exercise, lifestyle habits, and genetics, CKD medication management often requires input from multiple providers. When patients receive clear education about their condition and treatment, they are better prepared to make informed decisions that support stronger long-term outcomes. In addition, pharma regularly advances medications and introduces new therapy options for CKD care, so providers must stay closely connected with care teams and patients to understand how these developments should effectively be integrated into treatment plans. As new advancements are made and patients understand their options beyond the headlines and secondhand information, they will carry more confidence and compliance in treatment, resulting in better overall outcomes.
Photo: Stas_V, Getty Images
Dr. Tim Pflederer is the Chief Medical Officer of Evergreen Nephrology. Dr. Pflederer has spent 30 years caring for patients with kidney disease, in addition to serving as past president of the Renal Physician Association, and other organizations committed to improving healthcare at the national level. He is an experienced physician leader and clinician with experience in general and interventional nephrology, dialysis facility quality and safety, value-based care, coding and billing, and local and national advocacy for nephrology practices and patients.
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