Improving patient-centred outcomes through prevention: modifying lifestyle in patients with chronic kidney disease

Abstract

Patients with chronic kidney disease (CKD) are at an increased risk of mortality, life-threatening comorbidities and progression to end-stage kidney disease (ESKD) requiring dialysis or kidney transplant. Unfortunately, trial-based evidence to support the use of interventions for improving patient-reported outcomes is currently limited. This reiterates the need for effective strategies for prevention of progression to ESKD, which may help to improve overall survival and quality of life. Research priority setting partnerships with patients have consistently shown that prevention though lifestyle interventions are of highest priority to patients across all stages of CKD. Yet, the effect of these interventions may be limited by the lack of evidence about behaviour change techniques in the context of lifestyle interventions. Chapter 1 provides an overview of CKD, defines and outlines the need for identifying and implementing patient-centred outcomes, and outlines behaviour change techniques applied in lifestyle interventions in chronic kidney disease. Chapter 2 describes the principles and methods of the Delphi technique applied in the context of developing core outcomes in haemodialysis; and Chapter 3 reports the international Delphi survey with patients/caregivers and health professionals to gain consensus on critically important outcomes in haemodialysis. Chapter 4 is a systematic review that examines lifestyle interventions in patients with early-stage CKD and evaluates behaviour change techniques used in these interventions. This thesis generated original insights about the priorities of patients on haemodialysis, who give high priority to outcomes related to lifestyle and well-being, even above mortality and biochemical endpoints. Lifestyle interventions informed by behaviour change techniques are needed to help prevent the progression of CKD and thereby delay the debilitating impact of haemodialysis on the lives of patients with ESKD.