Background: In India there is scarcity of studies regarding medication non-adherence in CKD (chronic kidney disease) patients and there is lack of any prospective data. Objective: To study the prevalence and predictors of medication non-adherence in patients of CKD and outcomes of nonadherence prospectively over 2 years. Material and Methods: In this multi-centric, prospective observational study a total of 510 patients were included after obtaining consent. A validated scale of medication adherence, Morisky 8-item Medication Adherence Scale (MMAS-8) was used to calculate adherence. The primary outcome of the study was all-cause mortality and secondary outcome was composite of all-cause mortality and progression of CKD or occurrence of ESRD (end-stage renal disease). Results: Longitudinal evaluation showed increase in non-adherence over time, from 58% at baseline to 82% at two years. Overall, 18% patients were taking alternative medicines. The rate of all-cause death in low adherence population was numerically double as compared to patients with high adherence (1.4vs 0.7 per 100 patient-years), though the difference was statistically non-significant. The secondary outcome in low adherence population was 5.5 per 100 patient-years compared to 9.9 per 100 patient-years in high adherence population (hazard ratio [HR] = 1.53, 95% confidence interval [CI] = 1.21-1.74). __ampersandsignnbsp;Conclusion: Non adherence to medication is very prevalent among CKD patients in India, which further increases with duration of treatment. High use of alternative medicine was seen without physician__ampersandsignrsquo;s knowledge, especially in patients on haemodialysis. Moreover, we found that low medication adherence was significantly associated with composite of mortality and disease progression.__ampersandsignnbsp;