Self-management interventions for chronic kidney disease: a systematic review and meta-analysis

Suyuan Peng, Jiawei He, Jiasheng Huang, Longwei Lun, Jiahao Zeng, Shan Zeng, La Zhang, Xusheng Liu, Yifan Wu, Suyuan Peng, Jiawei He, Jiasheng Huang, Longwei Lun, Jiahao Zeng, Shan Zeng, La Zhang, Xusheng Liu, Yifan Wu

Abstract

Background: 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. 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.

Methods: We 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.

Results: We 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.

Conclusions: We 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.

Keywords: Chronic disease management; Chronic kidney disease; Self-management.

Conflict of interest statement

Competing interest

The authors declare that they have no competing interests.

Ethics approval and consent to participate

Not applicable.

Consent for publication

Not applicable.

Publisher’s Note

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Figures

Fig. 1
Fig. 1
Flow diagram of the stages of article inclusion for this systematic review
Fig. 2
Fig. 2
Pooled Estimates Comparing Self-management Intervention with Usual Care for All-cause Mortality; M-H, Mantel-Haenszel method; IV, independent variable method
Fig. 3
Fig. 3
Pooled Estimates Comparing Self-management Intervention with Usual Care for Risk of Dialysis; M-H, Mantel-Haenszel method; IV, independent variable method
Fig. 4
Fig. 4
Pooled Estimates Comparing Self-management Intervention with Usual Care for Changing on GFR; M-H, Mantel-Haenszel method; IV, independent variable method
Fig. 5
Fig. 5
Pooled Estimates Comparing Self-management Intervention with Usual Care for 24 h Urinary Protein Excretion; M-H, Mantel-Haenszel method; IV, independent variable method

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