Abstract
BackgroundSelf-management intervention aims to facilitate an individual’s ability to make lifestyle changes. The effectiveness of this intervention in non-dialysis patients with chronic kidney disease (CKD) is limited. In this study, we applied a systematic review and meta-analysis to investigate whether self-management intervention improves renoprotection for non-dialysis chronic kidney disease.MethodsWe conducted a comprehensive search for randomized controlled trials addressing our objective. We searched for studies up to May 12, 2018. Two reviewers independently evaluated study quality and extracted characteristics and outcomes among patients with CKD within the intervention phase for each trial. Meta-regression and subgroup analyses were conducted to explore heterogeneity.ResultsWe identified 19 studies with a total of 2540 CKD patients and a mean follow-up of 13.44 months. Compared with usual care, self-management intervention did not show a significant difference for risk of all-cause mortality (5 studies, 1662 participants; RR 1.13; 95% CI 0.68 to 1.86; I2 = 0%), risk of dialysis (5 studies, 1565 participants; RR 1.35; 95% CI 0.84 to 2.19; I2 = 0%), or change in eGFR (8 studies, 1315 participants; SMD -0.01; 95% CI -0.23 to 0.21; I2 = 64%). Moreover, self-management interventions were associated with a lower 24 h urinary protein excretion (4 studies, 905 participants; MD − 0.12 g/24 h; 95% CI -0.21 to − 0.02; I2 = 3%), a lower blood pressure level (SBP: 7 studies, 1201 participants; MD − 5.68 mmHg; 95%CI − 9.68 to − 1.67; I2 = 60%; DBP: 7 studies, 1201 participants; MD − 2.64 mmHg, 95% CI -3.78 to − 1.50; I2 = 0%), a lower C-reactive Protein (CRP) level (3 studies, 123 participants; SMD -2.8; 95% CI -2.90 to − 2.70; I2 = 0%) and a longer distance on the 6-min walk (3 studies, 277 participants; SMD 0.70; 95% CI 0.45 to 0.94; I2 = 0%) when compared with the control group.ConclusionsWe observed that self-management intervention was beneficial for urine protein decline, blood pressure level, exercise capacity and CRP level, compared with the standard treatment, during a follow-up of 13.44 months in patients with CKD non-dialysis. However, it did not provide additional benefits for renal outcomes and all-cause mortality.
Highlights
Self-management intervention aims to facilitate an individual’s ability to make lifestyle changes
Chronic kidney disease (CKD) is a progressive disease that leads to End-Stage Renal Disease (ESRD: maintenance dialysis or kidney transplantation), cardiovascular morbidity and mortality [1]
Search yield Computerized and manual searches resulted in 1737 unique citations, 1280 of which were excluded after reviewing their titles and abstracts
Summary
Self-management intervention aims to facilitate an individual’s ability to make lifestyle changes The effectiveness of this intervention in non-dialysis patients with chronic kidney disease (CKD) is limited. 440,000 patients begin dialysis each year worldwide, and annual costs of dialysis and kidney transplants range between US $35,000 and 100,000. This can strain healthcare budgets [2]. The goal of self-management is to identify strategies that can be used to help patients manage their condition(s) while leading active and productive lives This includes goal setting, problem solving, symptom management, and shared decision-making, and these strategies are applicable for a diverse population [7]. For patients with CKD, this encompasses a spectrum of behaviors ranging from adherence to medication, exercise, and diet recommendations (self-management maintenance) to recognition of early warning signs, and self-adjustment of home-care regimens
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