Nutritional Self-management of Chronic Kidney Disease: A Systematic Review and Co-created Qualitative Synthesis

Rationale & Objective Effective nutritional self-management is essential to reducing the risk of morbidity and mortality in chronic kidney disease (CKD). However, the most effective approach for delivering dietary interventions and supporting behavioural change remains uncertain. To inform future service delivery, a systematic qualitative evidence synthesis was conducted to understand patients’ experiences of their nutritional self-management of CKD. Study Design Systematic review. Setting & Study Populations Adults with CKD stages 1-5. Search Strategy & Sources MEDLINE, PsychInfo, and CINALH were searched from inception to 3 July 2023. Google Scholar and Web of Science were used for citation searching. Data Extraction All qualitative results from primary qualitative and mixed-method studies. Analytical Approach Thematic synthesis. Results Ninety-two studies involving 2,924 adults met the inclusion criteria across all stages. Studies reported experiences of multiple stages and modalities of treatment of CKD in 23 countries. Three themes and 8 sub-themes were identified related to nutritional self-management: navigating dietary advice (receiving advice, quality of advice, tailoring of advice), living a new life (mourning an old life, trial and error, enough is enough (re)gaining control) and diet as a social construct (social influences over management, stigma and isolation). Nutritional self-management in CKD is complex and multifaceted. Patients face significant problems in navigating dietary advice, adjusting to lifestyle changes, and managing social influences. Limitations Non-English language studies were excluded. Conclusions Adults living with CKD commonly face considerable challenges around dietary self-management across all stages of CKD and all modalities in stage 5. Incorporating dietary advice is highly complex, and current dietary service delivery often does not adequately meet patients' needs, regardless of their geographical location, stage of CKD, or treatment modality.