Kidney Week

Abstract: SA-PO0543

Mechanisms of Behavior Change and Treatment Adherence in Patients with CKD and Comorbid Depression

Session Information

• CKD: Clinical - Therapies, CKM Health, Special Populations, and More
  October 24, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: CKD (Non-Dialysis)

• 2202 CKD (Non-Dialysis): Clinical, Outcomes, and Trials

Authors

• McAdams, Meredith C., The University of Texas Southwestern Medical Center Department of Internal Medicine, Dallas, Texas, United States

Meredith C. McAdams, MD

• Hymowitz, Genna, Stony Brook University Renaissance School of Medicine, Stony Brook, New York, United States

Genna Hymowitz, PhD

• Gerardi, Giselle, Stony Brook University Renaissance School of Medicine, Stony Brook, New York, United States

Giselle Gerardi, PhD

• Goodman, Lynnel, The University of Texas Southwestern Medical Center, Dallas, Texas, United States

Lynnel Goodman, PhD

• Zhang, Xiaoyue, Stony Brook University Renaissance School of Medicine, Stony Brook, New York, United States

Xiaoyue Zhang

• Gregg, Lucile Parker, Baylor College of Medicine, Houston, Texas, United States

Lucile Parker Gregg, MD, MS, FASN

• Mehrotra, Rajnish, University of Washington School of Medicine, Seattle, Washington, United States

Rajnish Mehrotra, MD, MS, FASN

• Hedayati, Susan, Stony Brook University Renaissance School of Medicine, Stony Brook, New York, United States

Susan Hedayati, MD, MS, MSc, FASN

Background

Major depressive disorder (MDD) disproportionately affects people with CKD and is associated with non-adherence. We evaluated underlying facilitators of and barriers to adherence to MDD treatment interventions.

Methods

We conducted focus groups in participants who completed the 16-week CONCORD trial, and one-on-one semi-structured interviews with those who withdrew or stopped study drug. The multi-center CONCORD randomized controlled trial is evaluating two treatment strategies vs. control for MDD in people with CKD 3b-5: Behavioral Activation Therapy (BAT) via video-teleconferencing (and placebo) or the antidepressant bupropion (and clinical management via video-teleconferencing) administered in phase 1, with escalation to a combination of BAT and bupropion in phase 2 if remission is not achieved. The control arm receives clinical management via video-teleconferencing and placebo. An applied thematic analysis approach using NVivo 12 for coding was used to identify factors associated with adherence.

Results

Fourteen focus groups (N=52) and 7 one on one interviews were conducted. The cohort was 57% women, 29% African American, and 31% Hispanic persons. Median (IQR) age was 59 (51, 64) years. Adherence by pill count in phase 1 was median (IQR) 98% (92, 100) among focus group and 12.7% (0, 79) among one on one participants, p=0.0001. By end of phase 2, these were 98% (93, 100) in focus groups and 56% (19.6, 76.8) in the one on one group, p=0.0002. The proportion of participants that completed all teletherapy sessions in phase 1 was 78.8% vs. 100% in focus groups vs. the one on one group. For phase 2, the proportions were 88.5% and 71.4%, p, non-significant. Barriers to adherence were polypharmacy, large tablet size, side effects attributed to study drug, and forgetting to take medication. Facilitators of adherence were an expectation of symptom improvement and the desire to help others by the knowledge gained from the study. Participants reported a positive impact of participation on overall functioning and symptoms and indicated that skills learned and their relationship with the therapist were helpful elements of study sessions. Video-teleconferencing sessions were perceived to be more helpful than drug.

Conclusion

These findings may inform the design of future trials to improve adherence to treatment for MDD in people with CKD.

Acknowledgment

This work was supported by grants R01DK124379 and R01DK124379-03S1 from the NIH, NIDDK to Susan Hedayati.

Funding

• NIDDK Support