¹Department of Laboratory Technology, Shaikh Zayed Hospital, Lahore, Pakistan
*Correspondence: Habib Ullah ([email protected])

Received: 10 April, 2026; Revised: 30 May, 2026; Accepted: 04 June, 2026; Published: 10 June, 2026

ABSTRACT

Background: Chronic kidney disease (CKD) is a slowly developing condition with high burden of morbidity, mortality and healthcare utilization globally. The purpose of this study was to determine the level of CKD treatment adherence and its relationship with clinical outcomes. Methods: This was a cross-sectional analysis study which included 180 patients with CKD who were seen in nephrology outpatient clinics. The non-probability technique of convenience sampling was applied in selecting the participants. A structured questionnaire was used to gather information on socio-demographic data, treatment adherence behaviors, barriers to treatment adherence, and patterns of healthcare utilization. Data was analyzed with SPSS version 24.0 with p < 0.05. Results: In total, 180 patients participated, 36.7% of which were good adherence, 41.1% were moderate adherence and 22.2% were poor adherence. The patients with good adherence had significantly higher renal function (eGFR: 45.9 ± 16.3 mL/min/1.73m²) and lower serum creatinine level (2.8 ± 1.2 mg/dL) than those with poor adherence, as well as fewer hospitalizations and higher quality of life scores (p < 0.001). Adherence was significantly positively correlated with eGFR (r = 0.61, p < 0.001) and quality of life (r = 0.58, p < 0.001), and negatively correlated with serum creatinine (r = −0.55, p < 0.001) and hospitalization frequency (r = −0.49, p < 0.001). Multiple regression analysis revealed adherence score as the most important factor for eGFR (β = 0.46, p < 0.001), and also duration of CKD and diabetes and age. Conclusions: Adherence to treatment is an important factor to consider when evaluating clinical outcomes of CKD patients. Better adherence is closely linked to better renal function, fewer hospitalizations and better quality of life.

Keywords: Chronic kidney disease, treatment adherence, clinical outcomes, eGFR, quality of life, renal function, medication compliance.

Chronic kidney disease (CKD) is an irreversible disease that slowly worsens over time. It is a serious public health problem because of its growing prevalence, significant health costs and lengthened association with premature morbidity and mortality ¹. CKD is a condition that affects millions of people around the globe and is frequently the causative illness for other conditions like diabetes mellitus, hypertension, and cardiovascular disease ². Patients with declining kidney function suffer from a large number of complications such as electrolyte imbalance, anemia, cardiovascular disease, decreased quality of life and progression to end-stage renal disease (ESRD) needing dialysis or kidney transplantation ³.

Compliance with treatment plans is crucial in the management of CKD. Treatment adherence refers to taking medications as prescribed, diet and fluid requirements, frequent clinic visits, and following lifestyle changes as recommended ⁴. Good adherence is crucial to limiting disease progression, maintaining renal function, preventing complications, and better outcomes ^5,6. Treatment regimens for chronic kidney disease are complex, lifelong, and come with financial and psychological and social costs, however, rendering CKD patient adherence a significant challenge ⁷.

Prior research has shown that poor adherence has been linked to a more rapid decline in renal function, more hospitalizations, higher health care use, and decreased quality of life for CKD patients ⁸. Other factors contributing to adherence have been singled out by research, such as educational level, health literacy, socioeconomic factors, and complexity of treatment, family support, and access to care ⁹. Moreover, research has shown that the most frequent treatment adherence challenges encountered in patients with chronic kidney disease include forgetfulness, side effects of medications, financial restrictions, and lack of social support ¹⁰. Higher adherence has been consistently associated with better estimated glomerular filtration rate (eGFR), clinical stability and lower risk of disease progression ^11,12.

Although the significance of adherence in the management of CKD is now well understood, there are still reported differences in adherence patterns and adherence-clinical outcomes relationships across different healthcare settings and patient groups. Furthermore, there is limited literature on the interaction of treatment adherence, utilization patterns and patient barriers on renal outcomes and quality of life in CKD patients. Hence, the current study sought to determine treatment adherence in patients with Chronic Kidney Disease (CKD) and to determine its correlation with clinical outcomes such as renal function, hospitalizations, and quality of life. The study also aimed to determine the factors affecting adherence and prediction of good adherence to treatment for CKD patients attending nephrology outpatient clinics.

METHODOLOGY

This cross-sectional analytical study assessed the treatment adherence and its relation with clinical outcomes of CKD patients. The study was conducted in nephrology outpatient department of Shaikh Zayed tertiary care hospital Lahore from January 2022 to June 2022. The target population included adult adult patients with confirmed diagnosis of CKD who are followed on a regular basis. The study used a non-probability convenience sampling technique, which involved 180 individuals. Adults (18 years and older) with a known diagnosis of CKD (all stages), and at least 6 months of treatment were enrolled. Acute kidney injury, renal transplant, severe psychiatric illness, cognitive impairment to respond reliably and refusal were exclusion criteria. The ethical approval was taken before the beginning of the study from the institutional ethical committee. During the study, all participants gave written informed consent after being informed of the purpose and procedures of the study. Participation was voluntary at each step of the research process and confidentiality and anonymity of the participant data were preserved throughout the research process.

A structured, pretested questionnaire was used to gather data, and was based on previously validated adherence and chronic disease management instruments. The questionnaire consisted of four parts: socio-demographic information, clinical history, treatment adherence behaviors, and factors influencing adherence. The adherence to treatment was evaluated by medication adherence, adherence to diet, regularity of follow-up visits and adherence to the physician's recommendations. Important factors that hindered adherence were also documented, including financial problems, forgetfulness, side effects of treatment, and complex treatment regimens.

Patient clinical information such as the estimated glomerular filtration rate (eGFR), serum creatinine (SCr), chronic kidney disease (CKD) stage, comorbidities (hypertension and diabetes mellitus), hospitalisation frequency and QoL measures were extracted, with physician consent, from patient medical records. IBM SPSS version 24.0 was used to enter and analyze the data. Participant characteristics were summarized using descriptive statistics such as means, standard deviations, frequencies and percentages. Independent t-test and one-way analysis of variance (ANOVA) were used to compare clinical outcomes by levels of adherence. Pearson correlation analysis was used to examine relationships between adherence scores and clinical variables. Multiple linear regression analysis was used to find independent factors associated with renal function (eGFR), and logistic regression analysis was used to identify factors associated with good treatment adherence. P value < 0.05 was regards as statistically significant.

RESULTS

Overall, 180 patients were diagnosed with chronic kidney disease (CKD). The mean age of participants was 54.6 ± 13.2 years, and 58.3% were male. The overall treatment adherence was classified as poor (22.2%), moderate (41.1%), and good (36.7%) in the patients. Higher adherence was correlated with higher renal function parameters, less hospitalization rate, and higher quality of life scores. Table I shows the characteristics of chronic kidney disease patients in the study at the beginning. The majority of the participants were middle-aged to elderly, and there were a slightly higher number of males. Many patients were at a stage of CKD (3 and 4) and comorbid conditions like hypertension and diabetes were prevalent. The results showed a high clinical risk group; a high disease burden.

Table I: Demographic and Clinical Characteristics of CKD Patients (n = 180)

The overall treatment adherence was suboptimal, and there was a high percentage of moderate to poor adherence, as seen in Table II. Good adherence rates were only found in approximately one-third of participants. The mean adherence score represents partial adherence, and missed doses and follow-up visits further illustrate problems with sustained disease management.

Table II: Treatment Adherence Levels Among CKD Patients (n = 180)

Variable	Category	n (%)
Gender	Male	105 (58.3)
Female	75 (41.7)
Age (years)	<40	29 (16.1)
40–59	88 (48.9)
≥60	63 (35.0)
CKD Stage	Stage 1–2	32 (17.8)
Stage 3	61 (33.9)
Stage 4	54 (30.0)
Stage 5	33 (18.3)
Diabetes Mellitus	Yes	96 (53.3)
Hypertension	Yes	128 (71.1)
Dialysis Status	On Dialysis	48 (26.7)
Not on Dialysis	132 (73.3)

Variable	Category	Value
Adherence Score (Mean ± SD)		72.8 ± 14.6
Treatment Adherence	Poor	40 (22.2%)
Moderate	74 (41.1%)
Good	66 (36.7%)
Missed Medication Doses	Mean/month ± SD	4.1 ± 2.8
Missed Follow-Up Appointments	Yes	57 (31.7%)

Table III shows that there is a clear gradient in clinical results between adherence categories. Kidney function (eGFR) was significantly better, serum creatinine was significantly lower, and hospitalization rates were significantly lower and the quality of life scores were significantly higher in patients with good adherence. There was a strong relationship between adherence and clinical outcomes, with poor adherence always linked to poor outcomes.

Table III: Clinical Outcomes According to Treatment Adherence Level

Table IV highlights that better adherence was more common among younger patients, those with higher education, and those not on dialysis. Patients without diabetes and those who attended regular follow-ups also showed higher adherence rates. These findings suggest that both clinical status and socio-demographic factors influence adherence behavior.

Table IV: Medication Adherence According to Patient Characteristics

Outcome	Poor Adherence	Moderate Adherence	Good Adherence	p-value
eGFR (mL/min/1.73m²)	28.4 ± 12.7	36.8 ± 14.2	45.9 ± 16.3	<0.001
Serum Creatinine (mg/dL)	4.3 ± 1.6	3.5 ± 1.4	2.8 ± 1.2	<0.001
Hospitalizations/Year	2.4 ± 1.1	1.6 ± 0.9	0.9 ± 0.6	<0.001
Quality of Life Score	51.6 ± 10.8	63.4 ± 11.7	74.8 ± 12.3	<0.001

Variable	Good Adherence n (%)	p-value
Age <60 Years	46 (44.7)	0.018
Graduate/Postgraduate Education	39 (52.0)	0.006
Non-Dialysis Patients	55 (41.7)	0.021
No Diabetes Mellitus	40 (47.6)	0.014
No Missed Follow-Up Visits	52 (42.6)	<0.001

Table V shows significant correlations between treatment adherence and clinical indicators. Higher adherence was strongly associated with better kidney function (eGFR) and improved quality of life. Negative correlations were observed with serum creatinine, hospitalizations, and CKD duration, indicating that poor adherence contributes to disease progression and adverse outcomes.

Table V: Correlation between Adherence Score and Clinical Variables

Variable	Correlation Coefficient (r)	p-value
eGFR	0.61	<0.001
Quality of Life Score	0.58	<0.001
Serum Creatinine	-0.55	<0.001
Number of	-0.49	<0.001
Duration of CKD	-0.28	0.001
Age	-0.19	0.011

Table VI identifies key barriers to treatment adherence among CKD patients. The most commonly reported factors included complex medication regimens, financial burden, forgetfulness, and medication side effects. Logistic and social barriers such as transportation difficulties and lack of family support also contributed to poor adherence, highlighting the multifactorial nature of non-compliance.

Table VI: Factors Affecting Treatment Adherence

Factor	Agree n (%)
Complex Medication Regimen	102 (56.7)
Financial Burden	89 (49.4)
Forgetfulness	84 (46.7)
Medication Side Effects	72 (40.0)
Transportation Difficulties	58 (32.2)
Lack of Family Support	41 (22.8)

Table VII identifies treatment adherence as the strongest independent predictor of kidney function. Higher adherence significantly improved eGFR levels, while CKD duration, diabetes, age, and dialysis status negatively influenced outcomes. The model demonstrates that adherence plays a central role in determining renal function progression.

Table VII: Multiple Linear Regression Analysis for Predictors of Clinical Outcomes (eGFR)

Predictor	β Coefficient	p-value
Treatment Adherence Score	0.46	<0.001
CKD Duration	-0.24	0.003
Diabetes Mellitus	-0.21	0.008
Age	-0.17	0.021
Dialysis Status	-0.15	0.037

Table VIII shows that higher education, regular follow-up visits, and absence of financial burden significantly increased the likelihood of good adherence. Family support and younger age were also positive predictors. These findings indicate that both social support and healthcare access are critical determinants of treatment adherence in CKD patients.

Table VIII: Logistic Regression Analysis for Predictors of Good Treatment Adherence

DISCUSSION

Predictor	Odds Ratio (OR)	95% CI	p-value
Higher Education Level	2.48	1.31–4.68	0.005
Regular Follow-Up Attendance	3.16	1.72–5.79	<0.001
Absence of Financial Burden	2.11	1.14–3.89	0.017
Family Support	1.96	1.05–3.66	0.034
Younger Age	1.58	1.01–2.47	0.044

The current study evaluated the adherence of treatment in patients with chronic kidney disease and the correlation between adherence and clinical outcomes. The results showed poor adherence to treatment, with just 36.7% of patients exhibiting good adherence (the remainder moderate or poor). Additionally, treatment adherence had positive and significant associations with eGFR and quality of life and negative associations with serum creatinine and hospitalization rate. This evidence corroborates previous studies that suggest that adherence plays an important role in the success of treatment for CKD and that it also significantly impacts disease progression and patient health ¹³.

Adherence is a commonly reported problem in the care of chronic kidney disease (CKD) and the relatively low percentage of patients showing good adherence in the current study was not unexpected ¹⁴. Medications are frequently prescribed with a specific regimen, requiring patients to manage their targets from a distance, as is managing their fluid restrictions and diet, and patients may need to attend the clinic regularly for follow-up ¹⁵. In other studies, moderate adherence rates have been reported in CKD patients and were attributed to the complexity of the treatment and the long-term treatment needs and disease burden ¹⁶. This association between poor adherence with significantly lower eGFR and higher serum creatinine is similar to previous findings of increased renal function decline and higher risk of progression to advanced stages of CKD in individuals who did not adhere to treatment ¹⁷. Also, previous studies have revealed that adherence is associated with better control of CKD complications and better overall disease stability ^18,19.

One of the most relevant results of this study was the strong association between adherence and health outcomes, such as the number of hospitalization and the quality of life. Patients with poor adherence had significantly lower scores on the quality of life measures and significantly more hospitalizations than those with good adherence. This is consistent with other studies that have reported that compliance with treatment lowers the risk of complications, emergency visits and hospitalization in CKD patients ²⁰. Better adherence has also been linked to better physical functioning, symptom control and psychological well-being, which collectively have been linked to improved quality of life ^21,22.

The current study also revealed some factors that correlate with treatment adherence. Good adherence was associated with higher education, regular follow-up attendance, lack of financial burden, family support, and being younger ²³. These results corroborate earlier research suggesting that adherence behavior is significantly influenced by socioeconomic and healthcare-related determinants of disease management in chronic disease patients ²⁴. Financial burden was identified as a significant barrier in this study and has been reported in many studies as a factor that may prevent patients from obtaining treatment and using health services ^25,26. Furthermore, family support can enhance adherence by emotional encouragement, practical help and shared responsibility for managing the disease, which underscores the significance of social support systems in controlling CKD ²⁷.

The findings of this study may be interpreted with some limitations. The cross-sectional design does not allow causal inferences between adherence and clinical outcomes and self-reported adherence measures may be affected by recall and reporting bias. Moreover, the participants were recruited from selected nephrology clinics, which might affect the generalizability of the results. Future longitudinal and multicentre studies are recommended to further establish adherence pattern and the effectiveness of targeted educational, behavioural, and support-based interventions in enhancing adherence and long-term outcomes of patients with chronic kidney disease.

CONCLUSION

The present study revealed that adherence to treatment was sub-optimal and that there was a significant proportion of patients who were moderately or poorly adherent to treatment among patients with chronic kidney disease. Good adherence was significantly associated with better renal outcome, reduced hospitalizations and quality of life, highlighting the importance of adherence in effective CKD management.

The corresponding author declared that no other artificial intelligence or AI-assisted tools were used anywhere in this manuscript.

References

Journal of Biomolecules, Pathogenesis and Therapeutics, J Biomol Pathog Ther. 2026;2(2), p69-71 (jbptjournal.org) © 2026 Authors. This work is published by Multidisciplinary Scholarly Advancement and Research MSAR Institute. The full terms of Journal Publishing policy is available at https://jbptjournal.org/index.php/jbpt/-publishing-license and incorporate the Creative Commons Attribution – Non Commercial (CC BY, NC 4.0) License https://creativecommons.org/licenses/by-nc/4.0/. By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission, provided the work is properly attributed. Publisher’s Note: MSAR Institute remains neutral with regard to jurisdictional claims in published maps and institutional affiliations, and assumes no liability for the scientific accuracy or clinical efficacy of the content herein, as they rest entirely with the authors.

ORIGINAL ARTICLE

Treatment Adherence and Clinical Outcomes among Patients with Chronic Kidney Disease