Introduction

Chronic kidney disease (CKD) is a progressive and often asymptomatic condition marked by a substantial medication burden and complex therapeutic regimens. These challenges contribute to alarmingly low adherence rates—estimated at up to 70%—which in turn accelerate progression to end-stage renal disease (ESRD), increase hospitalizations, and elevate mortality risk. One-year mortality after ESRD initiation has been reported to reach 33.8%, highlighting the dire consequences of poor adherence.1,2

In response, digital health solutions have emerged as promising strategies to support treatment adherence in CKD. Among these, pharmacist-led mobile applications are gaining recognition for their capacity to bridge care gaps by combining technology with expert clinical oversight. These tools leverage pharmacists’ expertise in medication management, patient counseling, and follow-up to deliver personalized, accessible, and timely interventions. This article explores the impact of pharmacist-led mobile applications on medication adherence and clinical outcomes in CKD, with a focus on emerging evidence and opportunities for integration into routine care.3,4

Challenges in Medication Adherence Among CKD Patients

CKD patients often require polypharmacy to manage comorbidities such as hypertension, diabetes, mineral bone disorders, and anemia, with over 80% of patients taking five or more medications. Adherence is frequently undermined by complex dosing schedules, side effects, frequent medication changes, and a limited understanding of disease and treatment. Compounding these challenges are systemic issues such as fragmented care, low health literacy, financial barriers, and inadequate follow-up—particularly among vulnerable populations.5

Non-adherence in CKD is associated with faster renal decline, higher rates of hospitalization and cardiovascular events, and reduced quality of life. Studies report wide variability in non-adherence rates, ranging from 17% to 74%, underscoring the multifactorial nature of this issue. Addressing these barriers requires multifaceted interventions that are scalable, patient-centered, and adaptable to individual needs—an area where digital health tools, especially pharmacist-led apps, show considerable promise.6,7

Pharmacist-Led Mobile Applications: Design and Clinical Role

Pharmacist-led mobile applications are increasingly deployed in CKD care to enhance adherence, provide education, and support clinical decision-making. These apps typically feature medication reminders, dose tracking, symptom logging, interactive educational modules, and secure communication channels with pharmacists. Real-time monitoring allows pharmacists to track adherence trends, identify potential problems, and intervene early—either through virtual counseling sessions or by collaborating with physicians to adjust treatment plans.8

Educational content is often co-developed with clinical experts to ensure accuracy and relevance, helping patients better understand their condition and the importance of medication adherence. For example, the “Kidney Health” app demonstrated improved adherence and glycemic control in a randomized controlled trial. Other platforms, including Transplant Hero, Perx, My Dialysis, and iCKD, integrate various levels of pharmacist involvement, offering features such as gamification, pill scanning, and real-time alerts for missed doses or abnormal symptoms.9

Systematic reviews and meta-analyses support the efficacy of these digital interventions in improving adherence, enhancing patient satisfaction, and achieving clinical gains such as better blood pressure and glycemic control. Moreover, pharmacist-led apps are particularly valuable for delivering individualized care, facilitating medication reconciliation, responding promptly to patient concerns, and integrating adherence data with electronic health records. This connectivity enables a more coordinated, data-driven approach to CKD management.10

Real-world implementations also emphasize the importance of usability, data privacy, and interoperability. Pilot studies reveal that high user engagement and perceived usefulness are key to sustaining adherence and long-term benefits. As these technologies continue to evolve, incorporating patient feedback and advancing in AI capabilities, they are poised to become essential components of chronic disease management.11,12

Reference:

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  2. Benedikt Kolbrink, Katrin Schüssel, Friedrich A von Samson-Himmelstjerna, Grit Esser, Jürgen Floege, Ulrich Kunzendorf, Kevin Schulte, Patient-focused outcomes after initiation of dialysis for ESRD: mortality, hospitalization and functional impairment, Nephrology Dialysis Transplantation, Volume 38, Issue 11, November 2023, Pages 2528–2536, https://doi.org/10.1093/ndt/gfad099

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  8. Paneerselvam GS, Lua PL, Chooi WH, Rehman IU, Goh KW, Ming LC. Effectiveness of Mobile Apps in Improving Medication Adherence Among Chronic Kidney Disease Patients: Systematic Review. J Med Internet Res. 2025 Apr 16;27:e53144. doi: 10.2196/53144. PMID: 40239197; PMCID: PMC12044313.

  9. Ledo GVA, Lozada-Perezmitre E, Pruinelli L, Gómez Flores MI, Ramirez-Gonzalez LR. Validation of Educational Materials for a Mobile Application for Patients with Kidney Disease on Hemodialysis. Stud Health Technol Inform. 2024 Jul 24;315:114-118. doi: 10.3233/SHTI240117. PMID: 39049236.

  10. Ghozali MT, Satibi S, Forthwengel G. The impact of mobile health applications on the outcomes of patients with chronic kidney disease: a systematic review and meta-analysis. J Med Life. 2023 Sep;16(9):1299-1309. doi: 10.25122/jml-2023-0153. PMID: 38107714; PMCID: PMC10719786.

  11. Gamal S, Elseasi AMA, Sabry NA, Farid SF. Impact of pharmacist led mobile application on medication adherence and efficacy in chronic kidney disease. NPJ Digit Med. 2025 May 30;8(1):325. doi: 10.1038/s41746-025-01742-8. PMID: 40447835; PMCID: PMC12125339.

  12. Tesfaye W, Krass I, Sud K, Johnson DW, Van C, Versace VL, McMorrow R, Fethney J, Mullan J, Tran A, Robson B, Vagholkar S, Kairaitis L, Gisev N, Fathima M, Tong V, Coric N, Castelino RL. Impact of a pharmacy-led screening and intervention in people at risk of or living with chronic kidney disease in a primary care setting: a cluster randomised trial protocol. BMJ Open. 2023 Dec 20;13(12):e079110