Lifestyle Interventions in Improving Health Outcomes and Enabling People to Live Well with Kidney Disease

Lifestyle interventions can play an important role in improving patients' health outcomes and helping them to live well with chronic kidney disease (CKD). The key to living well is 'life participation', defined as 'the ability to do meaningful activities of life including, but not limited to, work, study, family responsibilities, travel, sport, social, and recreational activities'. Pharmaceutical, clinical, and surgical interventions such as dialysis and transplantation can deliver beneficial health outcomes for patients. Yet CKD patients say that the focus of renal appointments is 'bloods, urine, blood pressure and kidney function' and their treatment. Little time is provided to discuss non-clinical symptoms or concerns and recommend other treatments, such as lifestyle interventions. There are no highly ranked evidence-based guidelines for lifestyle interventions in CKD due to a historic lack of evidence. Diet advice, for example, is widely requested by patients on the internet and online forums but access to reliable information is highly variable. The lack of patient reported outcome measures (PROMs) is a barrier to monitoring and gathering evidence, but regulatory changes and the efforts of international organisations should soon deliver validated tools for research and guidelines which can be implemented in holistic care pathways. A global call to action to focus on lifestyle interventions is proposed.