Authors' reply

We thank Janet Butler for her correspondence regarding our recent article. She highlights the importance of non-adherence both for dialysis and transplant patients, with the potential consequences that may arise from this. This issue was discussed in our paper in relation to psychological adjustment and denial (De-Nour & Czaczkes, 1972), and the impact of adjustment disorder on physical outcome (House, 1989). The references given by the author give readers the opportunity to focus in more detail on the research relating to adherence and we are grateful to her for this. In relation to improving adherence in renal patients we would stress the importance of a fully informed, collaborative relationship between patient and physician in relation to the emergence and monitoring of medication side-effects. This can be supplemented by cognitive-behavioural therapy techniques aimed at ameliorating dysfunctional attitudes in relation to excessive needs for control, entitlement and achievement. Such strategies could be taught to renal staff on a workshop basis.