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.
  
  
  METHODS
  Systematic review of qualitative studies.
  
  
  METHODS
  Adults with CKD who express opinions about dietary and fluid management.
  
  
  METHODS
  MEDLINE, EMBASE, PsycINFO, CINAHL, Google Scholar, reference lists, and PhD dissertations were searched to May 2013.
  
  
  METHODS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Medicine, University of Otago Christchurch, Christchurch, New Zealand. Electronic address: suetonia.palmer@otago.ac.nz.
authors.forename: Suetonia C
authors.initials: SC
authors.lastname: Palmer
authors.affiliation: Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia.
authors.forename: Camilla S
authors.initials: CS
authors.lastname: Hanson
authors.affiliation: Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia; Sydney School of Public Health, University of Sydney, Sydney, Australia.
authors.forename: Jonathan C
authors.initials: JC
authors.lastname: Craig
authors.affiliation: Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia; Sydney School of Public Health, University of Sydney, Sydney, Australia; Department of Clinical Pharmacology and Epidemiology, Fondazione Mario Negri Sud, S. Maria Imbaro, Italy; Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy; Department of Translational Medicine, Division of Nephrology and Transplantation, Amedeo Avogadro University of Eastern Piedmont, Novara, Italy; Diaverum Medical Scientific Office, Lund, Sweden.
authors.forename: Giovanni F M
authors.initials: GF
authors.lastname: Strippoli
authors.affiliation: Diaverum Medical Scientific Office, Lund, Sweden.
authors.forename: Marinella
authors.initials: M
authors.lastname: Ruospo
authors.affiliation: Department of Nephrology, Princess Alexandra Hospital, Brisbane, Queensland, Australia; Translational Research Institute, Brisbane, Queensland, Australia.
authors.forename: Katrina
authors.initials: K
authors.lastname: Campbell
authors.affiliation: Department of Nephrology, Princess Alexandra Hospital, Brisbane, Queensland, Australia; Translational Research Institute, Brisbane, Queensland, Australia.
authors.forename: David W
authors.initials: DW
authors.lastname: Johnson
authors.affiliation: Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia; Sydney School of Public Health, University of Sydney, Sydney, Australia.
authors.forename: Allison
authors.initials: A
authors.lastname: Tong
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017281:Cost of Illness; D004035:Diet Therapy / Q000592:standards*; D005260:Female; D005440:Fluid Therapy / Q000592:standards*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010358:Patient Participation / Q000523:psychology; D010361:Patients / Q000523:psychology*; D036301:Qualitative Research; D011788:Quality of Life; D051436:Renal Insufficiency, Chronic / Q000523:psychology / Q000628:therapy*
keywords: Chronic kidney disease (CKD); dialysis; diet; fluid management; kidney transplant; patient perspective; patient-centered care; qualitative research; renal replacement therapy (RRT); thematic synthesis; treatment adherence