Dietary and fluid restrictions in CKD: a thematic synthesis of patient views from qualitative studies

Suetonia C Palmer, Camilla S Hanson, Jonathan C Craig, Giovanni F M Strippoli, Marinella Ruospo, Katrina Campbell, David W Johnson, Allison Tong

Research output: Contribution to journalArticleResearchpeer-review

59 Citations (Scopus)

Abstract

BACKGROUND: Managing the complex fluid and diet requirements of chronic kidney disease (CKD) is challenging for patients. We aimed to summarize patients' perspectives of dietary and fluid management in CKD to inform clinical practice and research.

STUDY DESIGN: Systematic review of qualitative studies.

SETTING & POPULATION: Adults with CKD who express opinions about dietary and fluid management.

SEARCH STRATEGY & SOURCES: MEDLINE, EMBASE, PsycINFO, CINAHL, Google Scholar, reference lists, and PhD dissertations were searched to May 2013.

ANALYTICAL APPROACH: Thematic synthesis.

RESULTS: We included 46 studies involving 816 patients living in middle- to high-income countries. Studies involved patients treated with facility-based and home hemodialysis (33 studies; 462 patients), peritoneal dialysis (10 studies; 112 patients), either hemodialysis or peritoneal dialysis (3 studies; 73 patients), kidney transplant recipients (9 studies; 89 patients), and patients with non-dialysis-dependent CKD stages 1 to 5 (5 studies; 80 patients). Five major themes were identified: preserving relationships (interference with roles, social limitations, and being a burden), navigating change (feeling deprived, disrupting held truths, breaking habits and norms, being overwhelmed by information, questioning efficacy, and negotiating priorities), fighting temptation (resisting impositions, experiencing mental invasion, and withstanding physiologic needs), optimizing health (accepting responsibility, valuing self-management, preventing disease progression, and preparing for and protecting a transplant), and becoming empowered (comprehending paradoxes, finding solutions, and mastering change and demands).

LIMITATIONS: Limited data in non-English languages and low-income settings and for adults with CKD not treated with hemodialysis.

CONCLUSIONS: Dietary and fluid restrictions are disorienting and an intense burden for patients with CKD. Patient-prioritized education strategies, harnessing patients' motivation to stay well for a transplant or to avoid dialysis, and viewing adaptation to restrictions as a collaborative journey are suggested strategies to help patients adjust to dietary regimens in order to reduce their impact on quality of life.

Original languageEnglish
Pages (from-to)559-573
Number of pages15
JournalAmerican Journal of Kidney Diseases
Volume65
Issue number4
DOIs
Publication statusPublished - Apr 2015
Externally publishedYes

Fingerprint

Chronic Renal Insufficiency
Peritoneal Dialysis
Renal Dialysis
Home Hemodialysis
Transplants
Negotiating
Patient Education
Self Care
MEDLINE
Habits
Disease Progression
Motivation
Dialysis
Emotions
Language
Quality of Life
Diet
Kidney

Cite this

Palmer, Suetonia C ; Hanson, Camilla S ; Craig, Jonathan C ; Strippoli, Giovanni F M ; Ruospo, Marinella ; Campbell, Katrina ; Johnson, David W ; Tong, Allison. / Dietary and fluid restrictions in CKD : a thematic synthesis of patient views from qualitative studies. In: American Journal of Kidney Diseases. 2015 ; Vol. 65, No. 4. pp. 559-573.
@article{10f7013fee9b4f2db18f3bee9d4379df,
title = "Dietary and fluid restrictions in CKD: a thematic synthesis of patient views from qualitative studies",
abstract = "BACKGROUND: Managing the complex fluid and diet requirements of chronic kidney disease (CKD) is challenging for patients. We aimed to summarize patients' perspectives of dietary and fluid management in CKD to inform clinical practice and research.STUDY DESIGN: Systematic review of qualitative studies.SETTING & POPULATION: Adults with CKD who express opinions about dietary and fluid management.SEARCH STRATEGY & SOURCES: MEDLINE, EMBASE, PsycINFO, CINAHL, Google Scholar, reference lists, and PhD dissertations were searched to May 2013.ANALYTICAL APPROACH: Thematic synthesis.RESULTS: We included 46 studies involving 816 patients living in middle- to high-income countries. Studies involved patients treated with facility-based and home hemodialysis (33 studies; 462 patients), peritoneal dialysis (10 studies; 112 patients), either hemodialysis or peritoneal dialysis (3 studies; 73 patients), kidney transplant recipients (9 studies; 89 patients), and patients with non-dialysis-dependent CKD stages 1 to 5 (5 studies; 80 patients). Five major themes were identified: preserving relationships (interference with roles, social limitations, and being a burden), navigating change (feeling deprived, disrupting held truths, breaking habits and norms, being overwhelmed by information, questioning efficacy, and negotiating priorities), fighting temptation (resisting impositions, experiencing mental invasion, and withstanding physiologic needs), optimizing health (accepting responsibility, valuing self-management, preventing disease progression, and preparing for and protecting a transplant), and becoming empowered (comprehending paradoxes, finding solutions, and mastering change and demands).LIMITATIONS: Limited data in non-English languages and low-income settings and for adults with CKD not treated with hemodialysis.CONCLUSIONS: Dietary and fluid restrictions are disorienting and an intense burden for patients with CKD. Patient-prioritized education strategies, harnessing patients' motivation to stay well for a transplant or to avoid dialysis, and viewing adaptation to restrictions as a collaborative journey are suggested strategies to help patients adjust to dietary regimens in order to reduce their impact on quality of life.",
author = "Palmer, {Suetonia C} and Hanson, {Camilla S} and Craig, {Jonathan C} and Strippoli, {Giovanni F M} and Marinella Ruospo and Katrina Campbell and Johnson, {David W} and Allison Tong",
note = "Copyright {\circledC} 2015 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.",
year = "2015",
month = "4",
doi = "10.1053/j.ajkd.2014.09.012",
language = "English",
volume = "65",
pages = "559--573",
journal = "American Journal of Kidney Diseases",
issn = "0272-6386",
publisher = "W.B. Saunders Ltd",
number = "4",

}

Dietary and fluid restrictions in CKD : a thematic synthesis of patient views from qualitative studies. / Palmer, Suetonia C; Hanson, Camilla S; Craig, Jonathan C; Strippoli, Giovanni F M; Ruospo, Marinella; Campbell, Katrina; Johnson, David W; Tong, Allison.

In: American Journal of Kidney Diseases, Vol. 65, No. 4, 04.2015, p. 559-573.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Dietary and fluid restrictions in CKD

T2 - a thematic synthesis of patient views from qualitative studies

AU - Palmer, Suetonia C

AU - Hanson, Camilla S

AU - Craig, Jonathan C

AU - Strippoli, Giovanni F M

AU - Ruospo, Marinella

AU - Campbell, Katrina

AU - Johnson, David W

AU - Tong, Allison

N1 - Copyright © 2015 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

PY - 2015/4

Y1 - 2015/4

N2 - BACKGROUND: Managing the complex fluid and diet requirements of chronic kidney disease (CKD) is challenging for patients. We aimed to summarize patients' perspectives of dietary and fluid management in CKD to inform clinical practice and research.STUDY DESIGN: Systematic review of qualitative studies.SETTING & POPULATION: Adults with CKD who express opinions about dietary and fluid management.SEARCH STRATEGY & SOURCES: MEDLINE, EMBASE, PsycINFO, CINAHL, Google Scholar, reference lists, and PhD dissertations were searched to May 2013.ANALYTICAL APPROACH: Thematic synthesis.RESULTS: We included 46 studies involving 816 patients living in middle- to high-income countries. Studies involved patients treated with facility-based and home hemodialysis (33 studies; 462 patients), peritoneal dialysis (10 studies; 112 patients), either hemodialysis or peritoneal dialysis (3 studies; 73 patients), kidney transplant recipients (9 studies; 89 patients), and patients with non-dialysis-dependent CKD stages 1 to 5 (5 studies; 80 patients). Five major themes were identified: preserving relationships (interference with roles, social limitations, and being a burden), navigating change (feeling deprived, disrupting held truths, breaking habits and norms, being overwhelmed by information, questioning efficacy, and negotiating priorities), fighting temptation (resisting impositions, experiencing mental invasion, and withstanding physiologic needs), optimizing health (accepting responsibility, valuing self-management, preventing disease progression, and preparing for and protecting a transplant), and becoming empowered (comprehending paradoxes, finding solutions, and mastering change and demands).LIMITATIONS: Limited data in non-English languages and low-income settings and for adults with CKD not treated with hemodialysis.CONCLUSIONS: Dietary and fluid restrictions are disorienting and an intense burden for patients with CKD. Patient-prioritized education strategies, harnessing patients' motivation to stay well for a transplant or to avoid dialysis, and viewing adaptation to restrictions as a collaborative journey are suggested strategies to help patients adjust to dietary regimens in order to reduce their impact on quality of life.

AB - BACKGROUND: Managing the complex fluid and diet requirements of chronic kidney disease (CKD) is challenging for patients. We aimed to summarize patients' perspectives of dietary and fluid management in CKD to inform clinical practice and research.STUDY DESIGN: Systematic review of qualitative studies.SETTING & POPULATION: Adults with CKD who express opinions about dietary and fluid management.SEARCH STRATEGY & SOURCES: MEDLINE, EMBASE, PsycINFO, CINAHL, Google Scholar, reference lists, and PhD dissertations were searched to May 2013.ANALYTICAL APPROACH: Thematic synthesis.RESULTS: We included 46 studies involving 816 patients living in middle- to high-income countries. Studies involved patients treated with facility-based and home hemodialysis (33 studies; 462 patients), peritoneal dialysis (10 studies; 112 patients), either hemodialysis or peritoneal dialysis (3 studies; 73 patients), kidney transplant recipients (9 studies; 89 patients), and patients with non-dialysis-dependent CKD stages 1 to 5 (5 studies; 80 patients). Five major themes were identified: preserving relationships (interference with roles, social limitations, and being a burden), navigating change (feeling deprived, disrupting held truths, breaking habits and norms, being overwhelmed by information, questioning efficacy, and negotiating priorities), fighting temptation (resisting impositions, experiencing mental invasion, and withstanding physiologic needs), optimizing health (accepting responsibility, valuing self-management, preventing disease progression, and preparing for and protecting a transplant), and becoming empowered (comprehending paradoxes, finding solutions, and mastering change and demands).LIMITATIONS: Limited data in non-English languages and low-income settings and for adults with CKD not treated with hemodialysis.CONCLUSIONS: Dietary and fluid restrictions are disorienting and an intense burden for patients with CKD. Patient-prioritized education strategies, harnessing patients' motivation to stay well for a transplant or to avoid dialysis, and viewing adaptation to restrictions as a collaborative journey are suggested strategies to help patients adjust to dietary regimens in order to reduce their impact on quality of life.

UR - http://www.scopus.com/inward/record.url?scp=84926333828&partnerID=8YFLogxK

U2 - 10.1053/j.ajkd.2014.09.012

DO - 10.1053/j.ajkd.2014.09.012

M3 - Article

VL - 65

SP - 559

EP - 573

JO - American Journal of Kidney Diseases

JF - American Journal of Kidney Diseases

SN - 0272-6386

IS - 4

ER -