Research Report- a Systematic Review

Introduction

Chronic kidney disease (CKD) is expected to become more common as people age, making it a major world health problem. Numerous elderly individuals have trouble sticking to the diets their doctors tell them to, even though strict diet control is necessary to slow the development of CKD and avoid health problems that come with it. The point of this comprehensive review is to collect and summarize information about how hard it is for older people with CKD to follow their doctors’ instructions for food while they are in outpatient therapy. By learning more about these problems, healthcare professionals, especially nurses, can help make focused treatments that help patients stick to their diets and improve their results. This review methodically gathers information on treatments that work well for older people with CKD. With this method, one looks through many databases and then does theme analysis on the papers they find. The goal is to provide valuable views for healthcare practices based on data.

1.1 Background

The world population is affected by chronic renal disease, which causes kidney function to decline over time and cannot be fixed. A longer life span means CKD will become much more common (Kovesdy, 2022). Nutritional control is significant for preventing health problems such as heart disease and starvation and delaying the start of chronic kidney disease. Researchers Naber and Purohit (2021) suggest that people with chronic kidney disease must strictly follow a changed diet for the best health results. However, some patients might need more suggested amounts of potassium, phosphorus, salt, and protein daily.

Available evidence shows that people of any age with CKD find it hard to follow food limits. Saglimbene et al. (2021) state that 20% and 70% of people with chronic kidney disease follow the recommended diet. It can be hard to follow the food rules for people with chronic kidney disease because they are complicated and vary from person to person (Opiyo et al., 2020). Individuals must make dramatic changes to what they eat and how they live to ensure they get enough calcium, sodium, potassium, and protein. Patients with CKD often experience feelings of sadness and confusion due to the lack of knowledge about how their condition affects their dietary choices (Opiyo et al., 2020). Additional research is needed to ascertain the long-term effects of these initiatives, notwithstanding their progress.

As people age, their feelings of smell and taste change, which makes it harder for them to stick to CKD diets. Opiyo et al. (2020) discovered that patients might not be able to stick to their treatment plans because of differences in culture, loneliness, or a lack of culturally appropriate food choices. People whose cultures do not allow them to eat certain nutrients found in traditional foods or who like to eat with other people are also at risk (Saglimbene et al., 2021). People who have many health problems and take many medicines may find it especially hard to deal with relationship fears. Some people, especially those with diabetes, may need to make more food changes to better control their illness (Saglimbene et al., 2021). Some people may feel more hungry when they take medicine, making it harder to stick to food limits.

Most people do not know about the unique problems older people with chronic kidney disease face when they go to outpatient clinics for care. More research needs to be done on the unique problems of the older community (Okoro et al., 2020). Researchers have already looked into why people do not follow diet rules. According to Saglimbene et al. (2021), this group’s mental skills worsen as they age. Because of this, people have a harder time taking responsibility for their health and following food restrictions. The main goal of this in-depth study is to find out what kinds of problems older people with chronic kidney illness have when they try to stick to their diet plans and go to their outpatient treatment meetings.

1.2 Aim and Objective

The primary objective of this in-depth study is to find out how hard it is for the elderly with CKD to stick to their diet plans while going to outpatient clinics.

Review Question: What are the biggest problems that older people with chronic kidney disease who go to outpatient clinics most of the time have when they try to stick to their treatment diet?

Methods

2.1 Study design

The method used for the study is a systematic review, and the main focus will be statistical information. Systematic reviews help researchers find the newest studies on a subject, usually ones related to policy or clinical practice. If the study were well managed, it would pick relevant studies, evaluate what they add to the field, analyze and combine the data, and show the results in a way that makes it easy to draw clear conclusions about what is known and what is unknown. Unlike a regular literature review, a systematic review is an independent research project that uses new studies to answer a clearly stated research question. A systematic review differs from other methods because it uses strict and independent standards to evaluate new information.

2.2 Inclusion Criteria

Researchers will pick papers for the systematic review based on their relevance and focus using the PICO (Population, Intervention, Comparison, and Outcome) standards. People 65 and older are the primary patients that outpatient programs for CKD target. These studies look at the specific problems that older patients have following the nutritional advice given by outpatient clinics for managing CKD. To keep the research up-to-date and valuable, the study will only look at English-language studies released in the last ten years (2014–2024) and use qualitative and quantitative methods.

Other factors may also affect the screening process when choosing a study. This group includes variables like the severity of chronic kidney disease (mild vs. severe), the type of dietary intervention (low-protein vs. Mediterranean diet), and the presence of any related co-morbidities, such as dementia. As the name suggests, this systematic review tries to answer the study question of the main problems that older CKD patients in outpatient clinics have with sticking to their therapy diet. As a result, it carefully chooses high-quality studies that meet specific admission standards and considers other relevant factors.

2.3 Search Strategy

A thorough search method will be used, and internet sources like Scopus, CINAHL, Google Scholar, and PubMed will be used. For better results, use Boolean operators like AND and OR to combine terms that are related to population (like “older people” and “CKD”), events (like “diet adherence” and “challenges”), and settings (like “outpatient clinics”). A typical search phrase is: “(elderly OR older adults) AND (chronic kidney disease OR CKD) AND (dietary adherence OR barriers OR challenges) AND (outpatient clinics).” The study’s essential reference lists will be reviewed by hand to find other pieces that fit the search criteria. A detailed PRISMA flow map will show the search and decision process. The number of studies found at each step of the process is shown in this graph, along with the studies that were thrown out and the exact reasons why.

2.4 Quality Appraisal

To ensure the study is reliable, the study will carefully check the scientific rigour of the chosen papers using well-known and trustworthy methods. The Critical Appraisal Skills Programme (CASP) tools were made by the Joanna Briggs Institute (JBI). They are well-known ways to evaluate both qualitative and quantitative healthcare studies. These tools make it easy to look at critical scientific factors that will help determine if a research study is accurate and reliable. Two separate reviewers will review each research study and use the proper JBI CASP method. If there are any disagreements, they will be talked over, or a third writer will be asked for their opinion. The evaluated factors allow for a fair and thorough review, with essential parts for scientific accuracy. Utilizing the JBI CASP standards, this study aims to boost trust in the research’s findings.

2.5 Data Extraction and Analysis

A standard form for extracting data will be made so that all the included studies can carefully record their study designs (qualitative and quantitative), subject information (age, CKD stage, sample size), tests used to measure food adherence, and stated barriers to adherence. Thematic analysis will be used to look at the collected data. Problems following nutritional rules found in earlier studies will be found, categorized, and analyzed. Describing the quantitative research results with descriptive statistics will help give a clear picture of the retention rates and the factors that affect them. It will be easy to see the main problems with sticking to a diet in each included study because a table will be made with just that information. Following food advice can be challenging for older people with CKD who do not live in a hospital. This systematic review uses various methods to get a complete picture of the problem.

Results

The articles identified for this review include 39 in the database search, 10 in the ECU World Search and Google Scholar searches, and 6 in the manual citation scanning procedure. After eliminating one duplicate, the total number of articles considered for the selection criterion was 54. Upon downloading all the remaining papers, we compared their abstracts and titles with the proposed inclusion and exclusion criteria. We excluded 39 studies that did not fulfil the specified criteria. Subsequently, we conducted a meticulous evaluation and identified 15 publications that met our predetermined criteria. The data unveiled four primary themes: patient-level factors, provider-level factors, and responses to treatment plans.

3.1 Study Characteristics

The study showed that several aspects could help or hurt people with chronic kidney disease who take their medications as prescribed. New ways to motivate people to reach their objectives have also been discovered. Baryakova et al. (2023), who support new medication delivery methods, discuss patient-centred ways to help people stick with their treatments. In 2022, Cardol et al. did a study to look into the factors that affect the health of people with chronic kidney illness positively or adversely. The research presented here shows how psychological factors affect behaviour differently.

Buosi et al. (2021) state that economic and healthcare problems make it hard for South African kidney institutions to help people with CKD. Hwang et al. (2020) look at how Singaporeans feel about healthcare to ensure that people with chronic kidney sickness take their medications as prescribed. Seng et al. (2020) did research on commitment trends and how they affect places with few resources is helpful. Also, an observational study was done by Seng et al. (2020)

Hospitals need to gain insight into how well people with CKD disease follow their treatment plans and what factors affect that. The 2020 study by Lin and Hwang gives a complete look at patient-centred self-management for people with CKD. Personalized care is essential to them, so they consider each patient’s needs. Several studies look at the problems that come up when people with chronic kidney illness try to stick to their treatment plans. Furthermore, they give cutting-edge medical advice that prioritizes patient’s needs and comfort.

3.2 Patient-Level Factors

Five studies were reviewed, and the results indicated that patient variables influenced the adherence to treatment among individuals with chronic renal disease. Research by Liu et al. (2023), Murali and Lonergan (2020), and Baryakova (2023) demonstrates that patients who are free, informed, and actively participating in their care are more likely to stick with it. Adhering to their treatment regimens may be difficult for those with little health knowledge. Baryakova et al. (2023) and Buosi et al. (2021) emphasize the significance of considering these factors to enhance therapy and ensure patients with chronic renal disease take their medications as directed. To achieve this, individuals must be given the right instruction, inspired to have optimistic attitudes and strong drives, and issues must be resolved.

3.3 Provider-Level Factors

Three studies discovered a connection between CKD patients who took their prescription drugs on time and service staff. Baryakova et al. (2023) recommend that individuals with CKD communicate with one another, abide by the guidelines, and take their medicines as prescribed. Buosi et al. (2021) state that clinical personnel should be knowledgeable about advanced care planning (ACP) have strong interpersonal skills and provide end-stage kidney disease (ESKD) patients with the resources they need to conduct effective ACP conversations and make informed decisions. Researchers Opiyo et al. (2020) discovered that providing individualized meals to CKD patients receiving hemodialysis, having specialists on care teams, and educating people about nutrition improve patient outcomes. Healthcare providers may assist patients with chronic kidney disease (CKD) in taking their drugs as recommended and have better outcomes by communicating, providing accurate information, and making resources accessible.

3.4 Response to Treatment Plans

An analysis of four trials revealed a connection between CKD patients’ adherence to their treatment regimen and their response to therapy. Cardol et al.’s team of researchers found that patients with CKD who are self-assured, have social support, and have autonomy over their care are more likely to adhere to treatment regimens. Buosi et al. (2021) state that societal norms, financial constraints, and a lack of other healthcare alternatives may make it difficult for those with CKD to take their medication. Rivera et al. examined CKD patients’ adherence to treatment regimens in 2022. Their research found that discussing your meds with your doctor makes it easier for you to take them as prescribed. According to Schrauben et al. (2022), persons with CKD could care better for their health when they received targeted, tailored assistance. Doctors and patients should concentrate on psychological issues, communicate more, and create individualized treatment regimens in order to keep CKD patients in therapy for longer.

Discussion

The study examined what drives people with chronic kidney disease to adhere to treatment. The fifteen studies examined three factors: the patient, the provider, and the reaction to the treatment plan.

Nurses watch and write down how well CKD patients follow their treatment plans. To meet their needs, people must know about CKD, its treatments, self-care, and outcomes. When making personalized care plans, they must consider the patient’s mental, physical, and social health. Nurses can help people with CKD get the right treatment, take their medications, change their food, and ensure they drink enough water. To give the best care, they work with doctors to ensure treatment plans are tailored to the needs of mental health patients and their families. By teaching people about what causes CKD, nurses give patients the power to get screened for it.

The review’s findings underscore the significance of nurses in advocating for laws that make it easier for nurses and other healthcare professionals to work together, teach patients how to take care of themselves and educate patients. There is much talk about how to make healthcare more accessible to people of different races and how to deal with the social and economic factors that affect health results. The results also shed light on the factors making CKD patients less likely to adhere to their treatment. The above is very important for healthcare professionals because it makes developing strategies to help patients easier.

This in-depth study analyses how well people with CKD take their medications, showing how complicated the issue is and how many things can cause it. It backs up Buosi et al. (2021), and Seng et al. (2020) found that patient education and discussion increase participation. Further, this study looks into how healthcare systems and cultural views affect dedication to medication. It comes up with new results similar to those of Cardol et al. (2022) and Okoro et al. (2020). Overall, the study offers insight into the mental parts of patient involvement, including effectiveness and drive, to help people understand better.

4.1 Limitation

Even though this study gives us significant data, it is essential to be aware of its flaws when we look at its results. Search strategies that include choosing the right words and sources may have made it possible to miss necessary research, which led to wholesome results. People may give more weight to good study results and ignore negative or unclear ones because of publication bias. Further, the different types of study designs and quality make it hard to make straight comparisons, which might influence the results. The review may only cover some aspects as it only looks at factors related to adhering, not the core processes or parts that were never measured. The study’s results might only apply to some people with CKD because the sample was too small and needed more people from different cultures, limiting its applicability.

Recommendations

Patient-centred therapy methods are highly recommended in professional practice as they include careful evaluations, making decisions together, and offering emotional support. Further, there is a need for enhanced communication and teamwork between individuals and healthcare workers. Priorities for education include incorporating patient education into regular treatment and improving healthcare workers’ understanding. There is also a need to prioritize promoting patient-centred care and handling the social factors affecting health policy. When studying, it is essential that treatments work and can be kept up for a long time. In order to improve patient results, quality of life, and healthcare costs, these suggestions may help healthcare professionals, trainers, and policy-makers get CKD patients to stick with their treatment more often.

Conclusion

The comprehensive systematic examines the extent to which older people with CKD follow their doctors’ advice about what to eat while they are getting outpatient care. The results of 15 studies were grouped into three main themes: variables at the patient level, factors at the provider level, and treatment plan reactions, highlighting several aspects that influence people’s adherence to medication, including their knowledge, attitudes, beliefs, communication, education, teamwork, drive, self-efficacy, cultural views, and financial limitations. Nurses can help individuals with CKD stick with their treatments by giving them information specific to them, making personalized treatment plans, handling social factors that affect health, and advocating for methods appropriate for their culture. The study suggests researching certain medicines, their long-term benefits and how people in different groups stick to their treatment plans. The paper highlights potential issues with the search methods and possible bias in the existing research and recommends enhancing future studies. Overall, the systematic review shows the complicated issues surrounding older people with CKD taking their medications as prescribed. This information will help doctors develop better ways to help these patients manage their condition and improve their health.

References

Baryakova, T., Pogostin, B. H., Langer, R., & McHugh, K. J. (2023). Overcoming barriers to patient adherence: the case for developing innovative drug delivery systems. Nature Reviews Drug Discovery, 22(5), 387–409. https://doi.org/10.1038/s41573-023-00670-0

Buosi, A. P. A., Paturkar, D., Dias, E. R., Estorninho, M. J., Kolawole, O., Ghooi, R., & Lutchman, S. (2021). The Rights of Patients with Chronic Kidney Disease in the World: Legal Perspectives and Challenges in Brazil, India, Portugal, South Africa, and Nigeria. In Contributions To Nephrology (pp. 322–338). https://doi.org/10.1159/000517722

Cardol, C. K., Boslooper‐Meulenbelt, K., Van Middendorp, H., Meuleman, Y., Evers, A. W. M., & Van Dijk, S. (2022). Psychosocial barriers and facilitators for adherence to a healthy lifestyle among patients with chronic kidney disease: a focus group study. BMC Nephrology, 23(1). https://doi.org/10.1186/s12882-022-02837-0

Hwang, S. J., Tan, N. C., Yoon, S., Ramakrishnan, C., Muthulakshmi, P., Gun, S., Lee, J. Y., Chang, Z. Y., & Jafar, T. H. (2020). Perceived barriers and facilitators to chronic kidney disease care among patients in Singapore: a qualitative study. BMJ Open, 10(10), e041788. https://doi.org/10.1136/bmjopen-2020-041788

Kövesdy, C. P. (2022). Epidemiology of chronic kidney disease: an update 2022. Kidney International Supplements, 12(1), 7–11. https://doi.org/10.1016/j.kisu.2021.11.003

Lin, C., & Hwang, S. (2020). Patient-Centered Self-Management in Patients with Chronic Kidney Disease: Challenges and Implications. International Journal of Environmental Research and Public Health, 17(24), 9443. https://doi.org/10.3390/ijerph17249443

Liu, J., Zhou, Y., Tang, Y., Chen, J., & Li, J. (2023). Patient engagement during the transition from nondialysis‐dependent chronic kidney disease to dialysis: A meta‐ethnography. Health Expectations, 26(6), 2191–2204. https://doi.org/10.1111/hex.13850

Murali, K., & Lonergan, M. (2020). Breaking the adherence barriers: Strategies to improve treatment adherence in dialysis patients. Seminars in Dialysis, 33(6), 475–485. https://doi.org/10.1111/sdi.12925

Naber, T., & Purohit, S. (2021). Chronic kidney disease: role of diet for a reduction in the severity of the disease. Nutrients, 13(9), 3277. https://doi.org/10.3390/nu13093277

Okoro, R. N., Ummate, I., Ohieku, J. D., Yakubu, S. I., Adibe, M. O., & Okonta, M. J. (2020). Kidney disease knowledge and its determinants among patients with chronic kidney disease. Journal of Patient Experience, 7(6), 1303–1309. https://doi.org/10.1177/2374373520967800

Opiyo, R. O., Nyawade, S. A., McCaul, M., Nyasulu, P., Lango, D. B., Were, A. J., Nabakwe, E. C., Bukania, Z., & Olenja, J. (2020). Perceptions on Adherence to Dietary Prescriptions for Adults with Chronic Kidney Disease on Hemodialysis: A Qualitative Study. Diseases, 8(3), 29. https://doi.org/10.3390/diseases8030029

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Saglimbene, V., Su, G., Wong, G., Natale, P., Ruospo, M., Palmer, S. C., Craig, J. C., Carrero, J. J., & Strippoli, G. F. (2021). Dietary intake in adults on hemodialysis compared with guideline recommendations. Journal of Nephrology, 34(6), 1999–2007. https://doi.org/10.1007/s40620-020-00962-3

Seng, J. J. B., Tan, J. Y., Yeam, C. T., Htay, H., & Foo, M. (2020). Factors affecting medication adherence among pre-dialysis chronic kidney disease patients: a systematic literature review and meta-analysis. International Urology and Nephrology, 52(5), 903–916. https://doi.org/10.1007/s11255-020-02452-8

Schrauben, S. J., Rivera, E., Bocage, C., Eriksen, W., Amaral, S., Dember, L. M., Feldman, H. I., & Barg, F. K. (2022). A Qualitative Study of Facilitators and Barriers to Self-Management of CKD. Kidney International Reports, 7(1), 46–55. https://doi.org/10.1016/j.ekir.2021.10.021

Table 1

Inclusion and exclusion criteria