Improving nonadherence in adolescents with kidney disease: a scoping review of interventions

OBJECTIVE: Advancements in immunosuppression have remarkably improved short-term allograft outcomes for adolescents with chronic and end-stage kidney disease (CKD/ESKD). However, long-term outcomes remain suboptimal, with nearly 35.4% of patients losing their allograft within 10 years. Adolescents are a high-risk group for premature graft loss and increased mortality compared with other age groups, and this is hypothesized to be partially due to higher rates of treatment nonadherence and underlying psychiatric comorbidities. METHOD: This scoping review provides an overview of existing interventions that were designed to improve treatment adherence among adolescent patients with CKD/ESKD. A comprehensive search of existing studies was conducted using four databases: PubMed, PsycINFO, CINAHL, and Web of Science. Data were charted using an Excel spreadsheet, and information extracted included author, year, country, study design, sample characteristics, interventions, measures, and key findings. RESULTS: Based on the inclusion criteria, nine studies were included in this review. Five articles focused on the pre-transplant phase, where participants either had early stages of kidney disease, were on dialysis, or were waitlisted for a transplant; and four focused on implementing interventions to improve adherence post-transplant. CONCLUSIONS: The findings offer valuable insights for the field, particularly the importance of implementing multicomponent interventions that target the developmental and psychological needs of adolescent patients. Critical knowledge gaps and implications for future research directions to improve adherence and long-term outcomes for this population are emphasized.