Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
BMC Nephrology
Published in: BMC Nephrology 1/2019

Open Access 01-12-2019 | Care | Research article

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

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

Published in: BMC Nephrology | Issue 1/2019

Login to get access

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.
Appendix
Available only for authorised users
Literature
1.
Go AS, Chertow GM, Fan D, McCulloch CE, C-y H. Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med. 2004;351(13):1296–305.PubMedCrossRef
2.
Webster AC, Nagler EV, Morton RL, Masson P. Chronic kidney disease. Lancet. 2017;389(10075):1238–52.PubMedCrossRef
3.
Keith DS, Nichols GA, Gullion CM, Brown JB, Smith DH. Longitudinal follow-up and outcomes among a population with chronic kidney disease in a large managed care organization. Arch Intern Med. 2004;164(6):659–63.PubMedCrossRef
4.
Di Angelantonio E, Danesh J, Eiriksdottir G, Gudnason V. Renal function and risk of coronary heart disease in general populations: new prospective study and systematic review. PLoS Med. 2007;4(9):e270.PubMedPubMedCentralCrossRef
5.
Levin A, et al. Global kidney health 2017 and beyond: a roadmap for closing gaps in care, research, and policy. Lancet. 2017;390(10105):1888-917.
6.
Peng S, Fan Y, Wang L, Wen A, Liu X, Liu H, Shen F. Leveraging Association Rule Mining to Detect Pathophysiological Mechanisms of Chronic Kidney Disease Complicated by Metabolic Syndrome. In: 2018 IEEE International Conference on Bioinformatics and Biomedicine (BIBM): 2018: IEEE; 2018. p. 1302–9. https://​ieeexplore.​ieee.​org/​abstract/​document/​8621226.
7.
Institute of Medicine Committee on Identifying Priority Areas for Quality I. In: Adams K, Corrigan JM, editors. Priority Areas for National Action: Transforming Health Care Quality. Washington (DC): National Academies Press (US) Copyright 2003 by the National Academy of Sciences. All rights reserved; 2003.
8.
McAndrew L, Schneider SH, Burns E, Leventhal H. Does patient blood glucose monitoring improve diabetes control? A systematic review of the literature. Diabetes Educ. 2007;33(6):991–1011 discussion 1012-1013.PubMedCrossRef
9.
Pillay J, Armstrong MJ, Butalia S, Donovan LE, Sigal RJ, Vandermeer B, Chordiya P, Dhakal S, Hartling L, Nuspl M, et al. Behavioral programs for type 2 diabetes mellitus: a systematic review and network meta-analysis. Ann Intern Med. 2015;163(11):848–60.PubMedCrossRef
10.
McManus RJ, Mant J, Haque MS, Bray EP, Bryan S, Greenfield SM, Jones MI, Jowett S, Little P, Penaloza C, et al. Effect of self-monitoring and medication self-titration on systolic blood pressure in hypertensive patients at high risk of cardiovascular disease: the TASMIN-SR randomized clinical trial. Jama. 2014;312(8):799–808.PubMedCrossRef
11.
12.
Moher D, Shamseer L, Clarke M, Ghersi D, Liberati A, Petticrew M, Shekelle P, Stewart LA. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev. 2015;4:1.PubMedPubMedCentralCrossRef
13.
14.
Higgins JPT, Altman DG, Gøtzsche PC, Jüni P, Moher D, Oxman AD, Savović J, Schulz KF, Weeks L, Sterne JAC. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ (Clinical research ed). 2011;343:d5928.CrossRef
15.
Borenstein M, Hedges LV, Higgins JP, Rothstein HR. A basic introduction to fixed-effect and random-effects models for meta-analysis. Res Synth Methods. 2010;1(2):97–111.PubMedCrossRef
16.
Egger M, Davey Smith G, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ (Clinical research ed). 1997;315(7109):629–34.CrossRef
17.
Peters JL, Sutton AJ, Jones DR, Abrams KR, Rushton L. Contour-enhanced meta-analysis funnel plots help distinguish publication bias from other causes of asymmetry. J Clin Epidemiol. 2008;61(10):991–6.PubMedCrossRef
18.
Harbord RM, Egger M, Sterne JA. A modified test for small-study effects in meta-analyses of controlled trials with binary endpoints. Stat Med. 2006;25(20):3443–57.PubMedCrossRef
19.
20.
Lopez-Vargas PA, Tong A, Howell M, Craig JC. Educational interventions for patients with CKD: a systematic review. Am J Kidney Dis. 2016;68(3):353–70.PubMedCrossRef
21.
Galbraith L, Jacobs C, Hemmelgarn BR, Donald M, Manns BJ, Jun M. Chronic disease management interventions for people with chronic kidney disease in primary care: a systematic review and meta-analysis. Nephrol Dial Transplant. 2018;33(1):112–21.PubMed
22.
Gibson PG, Powell H, Coughlan J, Wilson AJ, Hensley MJ, Abramson M, Bauman A, Walters EH. Limited (information only) patient education programs for adults with asthma. Cochrane Database Syst Rev. 2002;(2):Cd001005.
23.
Lee MC, Wu SV, Hsieh NC, Tsai JM. Self-management programs on eGFR, depression, and quality of life among patients with chronic kidney disease: a meta-analysis. Asian Nurs Res. 2016;10(4):255–62.CrossRef
24.
Lin MY, Liu MF, Hsu LF, Tsai PS. Effects of self-management on chronic kidney disease: a meta-analysis. Int J Nurs Stud. 2017;74:128–37.PubMedCrossRef
25.
Helou N, Dwyer A, Shaha M, Zanchi A. Multidisciplinary management of diabetic kidney disease: a systematic review and meta-analysis. JBI Database System Rev Implement Rep. 2016;14(7):169–207.PubMedCrossRef
26.
Bonner A, Havas K, Douglas C, Thepha T, Bennett P, Clark R. Self-management programmes in stages 1-4 chronic kidney disease: a literature review. J Ren Care. 2014;40(3):194–204.PubMedCrossRef
27.
Inker LA, Levey AS, Pandya K, Stoycheff N, Okparavero A, Greene T. Early change in proteinuria as a surrogate end point for kidney disease progression: an individual patient meta-analysis. Am J Kidney Dis. 2014;64(1):74–85.PubMedPubMedCentralCrossRef
28.
Middleton RJ, Foley RN, Hegarty J, Cheung CM, McElduff P, Gibson JM, Kalra PA, O'Donoghue DJ, New JP. The unrecognized prevalence of chronic kidney disease in diabetes. Nephrol Dial Transplant. 2006;21(1):88–92.PubMedCrossRef
29.
Padilla J, Krasnoff J, Da Silva M, Hsu CY, Frassetto L, Johansen KL, Painter P. Physical functioning in patients with chronic kidney disease. J Nephrol. 2008;21(4):550–9.PubMed
30.
Petersen AM, Pedersen BK. The anti-inflammatory effect of exercise. J Appl Physiol (Bethesda, Md : 1985). 2005;98(4):1154–62.CrossRef
31.
32.
Carrero JJ, Yilmaz MI, Lindholm B, Stenvinkel P. Cytokine dysregulation in chronic kidney disease: how can we treat it? Blood Purif. 2008;26(3):291–9.PubMedCrossRef
33.
Meuwese CL, Stenvinkel P, Dekker FW, Carrero JJ. Monitoring of inflammation in patients on dialysis: forewarned is forearmed. Nat Rev Nephrol. 2011;7(3):166.PubMedCrossRef
34.
Meuwese CL, Snaedal S, Halbesma N, Stenvinkel P, Dekker FW, Qureshi AR, Barany P, Heimburger O, Lindholm B, Krediet RT. Trimestral variations of C-reactive protein, interleukin-6 and tumour necrosis factor-α are similarly associated with survival in haemodialysis patients. Nephrol Dial Transplant. 2010;26(4):1313–8.PubMedCrossRef
35.
Jones F, Riazi A. Self-efficacy and self-management after stroke: a systematic review. Disabil Rehabil. 2011;33(10):797–810.PubMedCrossRef
36.
Lorig KR, Holman H. Self-management education: history, definition, outcomes, and mechanisms. Ann Behav Med. 2003;26(1):1–7.PubMedCrossRef
37.
Noar SM, Zimmerman RS. Health behavior theory and cumulative knowledge regarding health behaviors: are we moving in the right direction? Health Educ Res. 2005;20(3):275–90.PubMedCrossRef
38.
Corbin JM. Unending work and care: managing chronic illness at home (JOSSEY BASS SOCIAL AND BEHAVIORAL SCIENCE SERIES): Jossey-Bass; 1988.
39.
40.
Zhu Q, Tao C, Shen F, Chute CG. Exploring the pharmacogenomics knowledge base (PharmGKB) for repositioning breast cancer drugs by leveraging web ontology language (OWL) and cheminformatics approaches. Pac Symp Biocomput. 2014:172–82.
41.
42.
Shen F, Liu H, Sohn S, Larson DW, Lee Y. Predicate oriented pattern analysis for biomedical knowledge discovery. Intell Inf Manag. 2016;8(3):66–85.PubMedPubMedCentral
43.
Mayo-Wilson E. Reporting implementation in randomized trials: proposed additions to the consolidated standards of reporting trials statement. Am J Public Health. 2007;97(4):630–3.PubMedPubMedCentralCrossRef
44.
Li D, Wang Z, Wang L, Sohn S, Shen F, Murad MH, Liu H. A text-mining framework for supporting systematic reviews. Am J Inf Manage. 2016;1(1):1.
45.
46.
Zhang Y, Li D, Tao C, Shen F, Liu H. An integrative computational approach to identify disease-specific networks from PubMed literature information. In: 2013 IEEE International Conference on Bioinformatics and Biomedicine (BIBM): 2013: IEEE; 2013. p. 72–5. https://​ieeexplore.​ieee.​org/​document/​6732738
47.
Meuleman Y, Hoekstra T, Dekker FW, Navis G, Vogt L, van der Boog PJM, Bos WJW, van Montfrans GA, van Dijk S. Sodium restriction in patients with CKD: a randomized controlled trial of self-management support. Am J Kidney Dis. 2017;69(5):576–86.PubMedCrossRef
48.
Rossi AP, Burris DD, Lucas FL, Crocker GA, Wasserman JC. Effects of a renal rehabilitation exercise program in patients with CKD: a randomized, controlled trial. Clin J Am Soc Nephrol. 2014;9(12):2052–8.PubMedPubMedCentralCrossRef
49.
Teng HL, Yen M, Fetzer S, Sung JM, Hung SY. Effects of targeted interventions on lifestyle modifications of chronic kidney disease patients: randomized controlled trial. West J Nurs Res. 2013;35(9):1107–27.PubMedCrossRef
50.
Mustata S, Groeneveld S, Davidson W, Ford G, Kiland K, Manns B. Effects of exercise training on physical impairment, arterial stiffness and health-related quality of life in patients with chronic kidney disease: a pilot study. Int Urol Nephrol. 2011;43(4):1133–41.PubMedCrossRef
51.
Campbell KL, Ash S, Bauer JD. The impact of nutrition intervention on quality of life in pre-dialysis chronic kidney disease patients. Clin Nutr. 2008;27(4):537–44.PubMedCrossRef
52.
Flesher M, Woo P, Chiu A, Charlebois A, Warburton DE, Leslie B. Self-management and biomedical outcomes of a cooking, and exercise program for patients with chronic kidney disease. J Ren Nutr. 2011;21(2):188–95.PubMedCrossRef
53.
Leehey DJ, Moinuddin I, Bast JP, Qureshi S, Jelinek CS, Cooper C, Edwards LC, Smith BM, Collins EG. Aerobic exercise in obese diabetic patients with chronic kidney disease: a randomized and controlled pilot study. Cardiovasc Diabetol. 2009;8:62.PubMedPubMedCentralCrossRef
54.
Mekki K, Bouzidi-bekada N, Kaddous A, Bouchenak M. Mediterranean diet improves dyslipidemia and biomarkers in chronic renal failure patients. Food Funct. 2010;1(1):110–5.PubMedCrossRef
55.
Howden EJ, Coombes JS, Strand H, Douglas B, Campbell KL, Isbel NM. Exercise training in CKD: efficacy, adherence, and safety. Am J Kidney Dis. 2015;65(4):583–91.PubMedCrossRef
56.
Byrne J, Khunti K, Stone M, Farooqi A, Carr S. Feasibility of a structured group education session to improve self-management of blood pressure in people with chronic kidney disease: an open randomised pilot trial. BMJ Open. 2011;1(2):e000381.PubMedPubMedCentralCrossRef
57.
van Zuilen AD, Blankestijn PJ, van Buren M, ten Dam MA, Kaasjager KA, Ligtenberg G, Sijpkens YW, Sluiter HE, van de Ven PJ, Vervoort G, et al. Nurse practitioners improve quality of care in chronic kidney disease: two-year results of a randomised study. Neth J Med. 2011;69(11):517–26.PubMed
58.
Hotu C, Bagg W, Collins J, Harwood L, Whalley G, Doughty R, Gamble G, Braatvedt G. A community-based model of care improves blood pressure control and delays progression of proteinuria, left ventricular hypertrophy and diastolic dysfunction in Maori and Pacific patients with type 2 diabetes and chronic kidney disease: a randomized controlled trial. Nephrol Dial Transplant. 2010;25(10):3260–6.PubMedCrossRef
59.
Williams A, Manias E, Liew D, Gock H, Gorelik A: Working with CALD groups: Testing the feasibility of an intervention to improve medication selfmanagement in people with kidney disease, diabetes, and cardiovascular disease, vol. 8; 2012.
60.
Joboshi H, Oka M. Effectiveness of an educational intervention (the encourage autonomous self-enrichment program) in patients with chronic kidney disease: a randomized controlled trial. Int J Nurs Stud. 2017;67:51–8.PubMedCrossRef
61.
Ishani A, Christopher J, Palmer D, Otterness S, Clothier B, Nugent S, Nelson D, Rosenberg ME. Telehealth by an Interprofessional team in patients with CKD: a randomized controlled trial. Am J Kidney Dis. 2016;68(1):41–9.PubMedCrossRef
62.
Steed L, Lankester J, Barnard M, Earle K, Hurel S, Newman S. Evaluation of the UCL diabetes self-management programme (UCL-DSMP): a randomized controlled trial. J Health Psychol. 2005;10(2):261–76.PubMedCrossRef
63.
Williams A, Manias E, Walker R, Gorelik A. A multifactorial intervention to improve blood pressure control in co-existing diabetes and kidney disease: a feasibility randomized controlled trial. J Adv Nurs. 2012;68(11):2515–25.PubMedCrossRef
64.
Chan JC, So WY, Yeung CY, Ko GT, Lau IT, Tsang MW, Lau KP, Siu SC, Li JK, Yeung VT, et al. Effects of structured versus usual care on renal endpoint in type 2 diabetes: the SURE study: a randomized multicenter translational study. Diabetes Care. 2009;32(6):977–82.PubMedPubMedCentralCrossRef
65.
Chen SH, Tsai YF, Sun CY, Wu IW, Lee CC, Wu MS. The impact of self-management support on the progression of chronic kidney disease--a prospective randomized controlled trial. Nephrol Dial Transplant. 2011;26(11):3560–6.PubMedCrossRef
Metadata
Title
Self-management interventions for chronic kidney disease: a systematic review and meta-analysis
Authors
Suyuan Peng
Jiawei He
Jiasheng Huang
Longwei Lun
Jiahao Zeng
Shan Zeng
La Zhang
Xusheng Liu
Yifan Wu
Publication date
01-12-2019
Publisher
BioMed Central
Published in
BMC Nephrology / Issue 1/2019
Electronic ISSN: 1471-2369
DOI
https://doi.org/10.1186/s12882-019-1309-y

Other articles of this Issue 1/2019

BMC Nephrology 1/2019 Go to the issue

Research article

Changes in microparticle profiles by vitamin D receptor activation in chronic kidney disease – a randomized trial

Research article

An evaluation of phase angle, bioelectrical impedance vector analysis and impedance ratio for the assessment of disease status in children with nephrotic syndrome

Research article

Association between serum levels of interleukin-6 on ICU admission and subsequent outcomes in critically ill patients with acute kidney injury

Case report

Reduced membrane attack complex formation in umbilical cord blood during Eculizumab treatment of the mother: a case report

Research article

Expression of THSD7A in neoplasm tissues and its relationship with proteinuria

Research article

Effect of steroids and relevant cytokine analysis in acute tubulointerstitial nephritis
Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Reserve your place

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin
Prof. Florian Limbourg
Prof. Anoop Chauhan
Developed by: Springer Medicine
Obesity Clinical Trial Summary

At a glance: The STEP trials

Read more

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Pediatric Cardiology Video

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

Cardiopulmonary Comorbidity Video

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Valvular Heart Disease Video

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.

Watch now

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

16-04-2024 Type 2 Diabetes News

Incentivised to exercise

11-04-2024 Lifestyle Modifications News

New intervention for STEMI-related cardiogenic shock

10-04-2024 Myocardial Infarction News

» View more highlights on the ACC 2024 congress hub page

Image Credits