Article type
Year
Abstract
Background: Patients rank understanding the effectiveness of lifestyle programs, including diet, as their top treatment uncertainty in the treatment of kidney disease. However, existing research about the effects of specific dietary recommendations in kidney disease has not been summarized and does not account for patient experiences.
Objectives: To summarize effects of dietary advice among adults with kidney disease together with patient experiences to generate recommendations for research.
Methods: We conducted a systematic review of randomized controlled trials (RCTs) of any dietary intervention in chronic kidney disease and meta-analysis of treatment effects. Concurrently we did a thematic synthesis of qualitative studies of patient perceptions and experiences of dietary management. The two reviews were combined in a cross-study synthesis to identify potential dietary interventions informed by patient perspectives.
Results: Seventy-eight RCTs (5945 patients) with kidney disease evaluated dietary interventions including protein intake and type, olive oil supplements, and counselling. Outcome data were sparse and effects of dietary approaches on survival and quality of life were very uncertain. From 46 qualitative studies on the experiences of dietary restrictions involving 816 patients, we identified five themes. Patients reported that dietary interventions interfered with relationships, required navigation, led to constant fighting against temptation, allowed them the opportunity to optimize their health, and increased patient empowerment in healthcare. Cross-study synthesis showed that dietary recommendations are experienced intensely by patients, but issues such as social acceptance, self-efficacy, and navigating change are not considered within existing trials.
Conclusions: Our review identified a sparse evidence-base for dietary recommendations among people with kidney disease, which is grossly mismatched to the intense burden and importance of dietary modifications experienced by patients. Interventions that address a patient-centered research agenda including dietary implementation, social disruption and treatment effectiveness are needed.
Objectives: To summarize effects of dietary advice among adults with kidney disease together with patient experiences to generate recommendations for research.
Methods: We conducted a systematic review of randomized controlled trials (RCTs) of any dietary intervention in chronic kidney disease and meta-analysis of treatment effects. Concurrently we did a thematic synthesis of qualitative studies of patient perceptions and experiences of dietary management. The two reviews were combined in a cross-study synthesis to identify potential dietary interventions informed by patient perspectives.
Results: Seventy-eight RCTs (5945 patients) with kidney disease evaluated dietary interventions including protein intake and type, olive oil supplements, and counselling. Outcome data were sparse and effects of dietary approaches on survival and quality of life were very uncertain. From 46 qualitative studies on the experiences of dietary restrictions involving 816 patients, we identified five themes. Patients reported that dietary interventions interfered with relationships, required navigation, led to constant fighting against temptation, allowed them the opportunity to optimize their health, and increased patient empowerment in healthcare. Cross-study synthesis showed that dietary recommendations are experienced intensely by patients, but issues such as social acceptance, self-efficacy, and navigating change are not considered within existing trials.
Conclusions: Our review identified a sparse evidence-base for dietary recommendations among people with kidney disease, which is grossly mismatched to the intense burden and importance of dietary modifications experienced by patients. Interventions that address a patient-centered research agenda including dietary implementation, social disruption and treatment effectiveness are needed.