A Qualitative Exploration on Understanding Progression Patterns and Nursing Implications of Chronic Kidney Disease

doi:10.21203/rs.3.rs-4986469/v1

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A Qualitative Exploration on Understanding Progression Patterns and Nursing Implications of Chronic Kidney Disease

https://doi.org/10.21203/rs.3.rs-4986469/v1

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Introduction: Despite the alarming increase in the prevalence of Chronic Kidney Disease (CKD) worldwide owing to high-risk factors, little information is available on patients who experience consistent CKD progression. The purpose of this qualitative study was to explore the diverse courses of chronic kidney disease and understand illness perspectives from patients, fostering customized nursing approaches.

Methods: This qualitative study employed purposive and snowball sampling techniques to recruit 15 patients with CKD (stages 1 and 2) from the outpatient department of King Khalid Hospital. Data were collected through semi-structured interviews that lasted between 45 and 60 minutes, each with the participants’ consent for audio recording. Data were collected between March and April 2024. Thematic analysis was employed to analyze the transcriptions of the interviews.

Results: Four themes, including five subthemes, emerged from the verbatim accounts obtained from all 15 participants involved in this research. These are: (1) slow creep (The Range of Experiences in Early Stage CKD), (2) Balancing Act of Hope and Uncertainty (navigating a new reality), (3) turning point (contributory factors), and (4) CKD progression patterns (challenges managing CKD; Hopes, Fears, and Living with Uncertainty).

Conclusion: “slow creep,” which includes various experiences during initial diagnosis; “Balancing Act of Hope and Uncertainty” where emotional contradictions were raised, “Turning point marking an essential period in the progression of the illness; and lastly, “CKD Progression Patterns” which shows how difficult it is for someone to manage uncertainty through one’s emotions. This understanding offers a framework for understanding early stage CKD, but more studies need to be conducted before any conclusive statements can be made about them.

Health sciences/Nephrology

Health sciences/Nephrology/Kidney diseases/Chronic kidney disease

Health sciences/Health care

Health sciences/Health care/Disease prevention

Health sciences/Health care/Quality of life

CKD progression

patterns

turning point

balancing act

Saudi Arabia

qualitative

Chronic Kidney Disease (CKD) is a significant and rising global problem, with its increasing prevalence posing a critical public health challenge. Earlier studies have shown an increased occurrence of CKD and a separate association with cardiovascular diseases [1, 2]; hence, the need for proactive handling of CKD is of paramount importance. This phenomenon affects approximately 10–13% of the global population, which is more than 500 million people worldwide, showing the importance of this problem [3]. Because of its population with a high prevalence of diabetes mellitus, hypertension, and obesity, Saudi Arabia is one of these countries facing a huge burden of CKD [4, 5]. In fact, a recent survey found that in Saudi Arabia, the rate was at least 4.4% for stages three through five chronic kidney disease, thus evidencing the dire need for targeted intervention strategies and early detection mechanisms [6].

Early recognition and management of CKD constitute crucial steps towards reducing disease progression, as argued by Johnson et al. [7]. Diagnosis at an early stage, along with appropriate therapies, can significantly influence outcomes in patients with CKD, slowing down or preventing its progression. However, in terms of this burden, it emphasizes the need for preventive screening, lifestyle modification, and personalized treatment in Saudi Arabia. Little is known about the factors that consistently lead to linear acceleration of ESRD or death in these patients. Such a population might be important because their linear eGFR trajectory represents the true form of CKD [8]. Public awareness of CKD is a significant predictor of undergoing testing programs, which is the major strategy to identify and minimize CKD burden [9]. This gap indicates that more research needs to be conducted on the progression patterns of chronic kidney diseases among high-risk groups such as those living in Saudi Arabia.

Proactive screening, such as regular check-ups and early identification of risk factors for CKD, can help in timely management. In addition, lifestyle changes include adjustments in one’s diet plan, physical exercises, and weight control to prevent or slow the progression of kidney disease [7]. Furthermore, using individually tailored treatment plans according to the CKD stage and the presence of comorbidities such as dialysis or kidney transplantation may significantly improve outcomes and prolong the need for more advanced interventions. In Saudi Arabia, where CKD is highly prevalent, it is mandatory for policymakers to collaborate with health care providers and the public to prioritize early detection and management. Therefore, by addressing both risky behaviors that lead to chronic kidney disease and its increase within Saudi Arabia’s population at large, proactive measures can be taken to mitigate the future potential consequences of this public health challenge. The purpose of this qualitative study was to explore the diverse courses of chronic kidney disease and understand illness perspectives from patients, fostering customized nursing approaches. This subset will work towards researching precursors for fast-progressing CKD. Consequently, there is still a dearth of knowledge regarding the linear progression of CKD, thus necessitating qualitative studies among Saudi patients in order to shed some light on these conditions.

Research Design:

This study employed a qualitative design to explore the diverse courses of chronic kidney disease and understand illness perspectives from patients fostering customized nursing approaches. Consolidated Criteria for Reporting Qualitative Research (COREQ) were employed to emphasize the importance of describing the chosen data analysis method and the steps involved in this study.

Setting/ Participants

This study was conducted at the King Khalid Hospital outpatient department with 15 participants (11 males and 4 females) participants age ranging–22–55 years old. The participants underwent a follow-up checkup in the outpatient department. Purposive and snowball sampling were used to identify participants. Purposively, the participants were diagnosed with CKD 1 and 2, aged 18 years and above, and willing to participate. However, saturation was not achieved with the initial nine participants; therefore, the researchers employed snowball sampling to reach additional participants through existing social networks of the initial group. The researchers asked the participants if they knew anyone else diagnosed with CKD stages 1 or 2 who was interested in the study. In this study, saturation was achieved with Participant 15.

Data collection

A key person in the outpatient department asked the individual patient if they wanted to participate in ongoing research. Once the participant agreed, the key person asked the participant to go to a waiting room where the researcher explained the study, the procedure, and their extent of participation. After the explanation, the participant will be given ample time if they want to be involved. All participants who agreed to participate were given a consent form that they signed before participating in the study. Participants determined when and where the interviews were conducted. Two men and three women represented the four interviewees. Four of the interviewees (all doctors of philosophy holder) are working in academe, while one is employed in hospitals (Master’s holder), and they have all experience of interviewing people over a long time period. The interviewers did not know their participants directly and had not met them before. Before proceeding with the actual interviews, the researchers asked all participants for permission to record the conversation during the interviews. To guide the researcher, semi-structured questions were posed as instruments for the data collection. One grand question can serve as an example; “What are experiences of patients with CKD living in north-western part of Saudi Arabia?” The probing questions consisted of statements such as ‘Can you tell me more about this? Can you explain what you mean?” The minimum duration spent per patient during the interview was between 45 minutes and one hour. It took more than a month to complete these interviews depending on the availability of the subjects being interviewed, and participants’ views were subsequently reviewed by two other colleagues who summarized meaningful statements derived from recorded transcripts before thematic analysis, leading to the development of themes. The team discussed the themes and agreed on what constituted them. Data collection was conducted from March to April 2024. Researchers have developed methods for conducting this study. After the researchers completed their part, a check was made to confirm the amount of data that they had gathered, and the participants also confirmed its validity as required in such situations. This was done so that full transcriptions were available for these researchers’ descriptions of their individual conditions. One of the interventions given by the researches involved debriefing, which dealt with patients’ psychological distress.

Ethical consideration

This study was approved by the Institutional Review Board of the University of Ha’ il (H-2023-0134). During one-on-one interviews, participants were informed about the purpose and importance of research along with rights, such as the freedom to leave any time upon request. Participants’ rights, including anonymity and confidentiality, were respected throughout the study.

Data Analysis

In this study, the collected data were analyzed using thematic analysis. It helps discover patterns or themes hidden within qualitative data by identifying and interpreting them where possible. The collected data were analyzed using thematic analysis, a qualitative research method that helps discover and interpret patterns or themes hidden within the data. This involved an initial familiarization phase where I immersed myself in the interview transcripts by reading and re-reading them to gain a comprehensive understanding of the participants' experiences. Subsequently, I identified and coded segments of data that captured important concepts or recurring ideas. These initial codes were then grouped into broader categories (themes) that reflected similar patterns or meaning across the data. Finally, the themes were reviewed and refined to ensure they accurately represented the data and addressed the research question.

Based on the verbatim accounts of the 15 participants, four themes and five sub-themes emerged. This includes: (1) Slow creep with the subtheme “Range of Experiences in Early Stage CKD.”, (2) Balancing Act of Hope and Uncertainty with subtheme “navigating a new reality,” (3) turning point with subtheme “contributory factors,” and (4) CKD progression patterns with subtheme “challenges managing CKD and “Hopes, Fears, and Living with Uncertainty. “Table 1 presents the demographic information of the participants.

Table 1

Demographic information of the participants. N = 15
Participant	Age	Gender	Diagnosis prior to CKD
Participant 1	22	Male	Diabetes Mellitus
Participant 2	53	Male	Diabetes Mellitus
Participant 3	33	Male	Obesity
Participant 4	42	Female	Diabetes Mellitus/ Glomeronephritis
Participant 5	55	Female	Diabetes Mellitus
Participant 6	48	Female	Obesity
Participant 7	54	Male	Smoker/ Diabetes mellitus
Participant 8	49	Male	Diet/ Obesity
Participant 9	40	Female	Obesity
Participant 10	46	Male	Hypertension
Participant11	54	Male	Diabetes mellitus
Participant 12	36	Male	Obesity
Participant 13	48	Male	Diabetes Mellitus
Participant 14	54	Male	Diabetes Mellitus
Participant 15	28	Male	Obesity

Theme 1: Slow creep

The term “slow creep” indicates that CKD can progress quietly without causing significant ripples until it reaches more advanced stages. Therefore, there is a need for regular check-ups and an understanding of the possible risk factors. Chronic kidney disease (CKD) can sometimes be a sly devil with regard to time. In some participants, the early symptoms may be insidious. For instance, it is slightly more tired than usual and frequent night urination. These are often overlooked as normal events or attributed to different factors. Failure to recognize early symptoms of CKD may delay diagnosis and treatment, necessitating early intervention. That is;

Participant 1: Until now I have not had any though but learning about CKD has been a wake-up call for me regarding how I handle my health care decisions; henceforth am observant on my blood pressure levels and tend to drink a lot of water every day as prescribed by my doctor- this was what one participant said.

Participant 2: At 53 years old…Looking back, maybe I should have paid more attention when I started getting up two or three times at night just to pee…But then again, maybe it was just an age thing or something like that persons with poor memory have”.

Participant 3: As I read through this too and made connection with my present condition since my father had CKD, it felt obvious that I was at risk. It’s tough going mentally, but am trying hard to remain positive and proactive.

These initial reactions from participants showcase the varied ways individuals come to terms with CKD diagnosis in the early stages. This diversity of experience indicates that early stage CKD is experienced in a range of ways, thus emphasizing the complex nature of this stage in the disease trajectory.

Subtheme 1: The Range of Experiences in Early Stage CKD.

This subtheme demonstrates how experiences differ at different CKD stages. Some may have no physical changes, whereas others may only display subtle symptoms, such as tiredness and urination. Importantly, this theme recognizes that different responses occur under fear and hope depending on individual circumstances. As reported by the participants:

Participant 4: A little scared but also a bit positive. I have been told things that I can do to slow down, and I intend to do everything possible to stay healthy.

Participant 6: My CKD is still in its early stages, so there have been no physical changes. Emotionally, I am slightly worried about what lies ahead, but my main focus at the moment is on good health practices.

Participant 7: I slightly noticed some symptoms like fatigability, and I feel worried about what happens if I am unable to cope with an active lifestyle?

This shows how ill people experience the disease’s initial stages differently. Physical changes did not occur in some individuals, such as participant number six (Participant 6). Still, others, such as Participant 2, exhibit miniscule signs of illness formerly excused by old age. Additionally, this theme recognizes various emotional reactions to a life-changing diagnosis, including fear combined with hopefulness.

This variation in experience is parallel with Theme Two, which examines more closely the emotional rollercoaster that many patients face when they learn they have CKD- both hope for the future and anxieties to simultaneously coexist.

Theme 2. Balancing hope and uncertainty

This describes the journey taken by participants in situations where the future is unclear and stresses the importance of maintaining positive outlooks as well as realistic expectations about what one does not know.

Participant 15: Indeed, I am slightly frightened, but with some optimism. I have, however, resolved everything within my means so that I remain healthy and maintain a normal weight. Am not just fat but also obese.

Participant 12: So far, I have not had any physical changes yet because my CKD is still in its early stages. However, there are emotional uncertainties regarding the future that I am trying to overcome for my health’s sake.

Participant 1: No physical changes yet, but I worry about what happens next if I do not sustain this highly active lifestyle.

These thoughts from respondents explain Subtheme 2 ’navigating a new reality’. This was observed across different body conditions that all went along with each individual adapting to a new health situation due to CKD.

Subtheme 2: Navigating a new reality

While a different diagnosis can alter the course of life, it changes the way a participant comprehends their health and makes their future appear less bright by limiting their options. This theme refers to the circumstances under which people need to navigate. It is not just about accepting the diagnosis, but also how to move on with one's life by it. There is an emotional impact that must be dealt with: one needs to make adjustments to their day-to-day activities and seize control over what they can handle.

Participant 2: I find I get out of breath more quickly when climbing stairs, and my skin feels drier. Emotionally frustrating because most of the time I feel fine, but I know things could change.

Participant 3: Honestly, I feel mad. First, I asked myself why I had it? Instead, I focus on things over which I have some control, such as diet and exercise.

These reflections on adapting to physical changes and managing emotions point towards Theme 3 “Turning Point.”

Theme 3. Turning point

This aspect focuses on a decisive moment in the lives of patients with CKD when their views and feelings towards the illness have undergone drastic alterations. It is about moving from probably denying or being ignorant of how this ailment affected them to an active admission and maybe even dread regarding its worsening. The nature of this turning point can differ, such that it may be a particular sickness incidence or appointment with a doctor who has given worrying information or is just getting weakened.

Some participants had a significant shift in their perception, whereby they were diagnosed with (blood test results) or clearly told their possible implications (dialysis). The realizations made them suddenly more determined to take care of themselves and make healthier choices for their well-being. Commenting on specific moments that could be marked as crises in their journey through CKD. Some respondents lamented the following.

Participant 1: For sure, high creatinine levels in blood tests are extremely abnormal. Now I am determined to stop it from progressing further by listening to my doctor.

Participant 2: When my doctor explained the potential for dialysis because of my blood urea nitrogen (BUN) and creatinine increasing results, it scared me from making some serious changes.

Participant 3: My dad’s face changed when I informed him of my diagnosis. At that moment, I understood that I should act for myself and for my future life. To hear that I had CKD was shocking, it inspired me to make lifestyle modifications.

The turning point gave them a better understanding of CKD, leading them to take action. Altered conduct is a common result in various instances, such as healthy living or seeking evaluations on how to manage CKD. As the respondents’ narratives suggest, turning points are usually triggered by specific incidents or revelations. Subtheme 3: Contributory Factors critically examine these triggers by exploring the times when there was a change in comprehension and resolution to face CKD management.

Subtheme 3: Contributory factors

To prevent and manage this disease, it is important to understand the causes of CKD progression. Kidneys gradually fail over time, which is sometimes referred to as chronic kidney disease (CKD). While the cause may vary, various factors contribute to its development and advancement. In this subtheme, these contributing factors are discussed based on participants’ experiences.

Participant 5: I have type II diabetes mellitus, which I am managing with my doctor, so as to hopefully slow down how fast CKD develops.

Participant 10: I understand clearly that it is crucial for me to keep my blood pressure normal.

Participant 2: According to my physician, it could be a combination of diabetes and a family history.

Participant 9: In the past, I ate too much processed food and did not exercise often enough; I am currently working on changing those habits.

Participant 4: Sometimes, I struggle with urinary tract infections (UTIs). My doctor told me that this might have hampered the proper functioning of the kidneys.

Participant 6: This can put strain on your kidney since I weigh it more than necessary.

Participant 7: It was only after 15 years of smoking that I decided to quit thinking whether it was related to my earlier diagnosis of CKD this year.

Participant 8:I used to drink sugary sodas and eat fast food several times a week. Additionally, there was never enough time for me to exercise at any given time.

Theme 4. CKD progression patterns

This theme concerns the various ways in which chronic kidney disease progresses over time. CKD is a progressive condition, and its rate and manner of deterioration vary from person to person. Although CKD worsens over time, different participant experiences are shown. According to the participants:

Participant 14: My blood result shows an abnormal pattern I experienced this period when my kidney function was gradually deteriorating and I realized that I had to slow it down.

Participant 13: “I just do not want to start dialysis.” According to my doctor, there could be a steeper decline, possibly due to uncontrolled diabetes. This scared me when doctors told me about this, you know what… it was like a sort of waking up call for me not to cause further harm.

Participant 3: When my doctor predicted that major lifestyle changes might eventually stabilize me, my kidneys may not get any worse off for a while. “I can reach a point after some radical life style change;” my doctor explained; “whereby, even if I live on, my kidneys will not get worse.”

Participant 7: According to what my doctor told me, if I stopped smoking completely and lead a healthy lifestyle, I may see some slight improvements in health, sometimes even recover or reverse some damages.

Subtheme 4. Challenges in managing CKD

This subtheme discusses the many problems people with CKD face when managing their condition. These challenges underscore the need for a holistic approach to CKD management, which should not only focus on the physical aspects, but also cover the emotional and social well-being of individuals. Most respondents pointed out that making and adhering to healthier lifestyles were among the most formidable challenges they experienced. In addition, medical adherence and emotional impact of CKD diagnosis can be emotionally draining, with participants expressing feelings of worry, frustration, anger, and fear. Another obstacle is how one can maintain their emotions while having a realistic view of the disease and its progression as an individual faces this situation. That is;

Participant 8: The biggest hurdle is to completely change my lifestyle habits. It is hard to break old habits such as eating too much sugar, especially when I feel alright.

Participant 4: The hardest part was keeping up with the healthy diet plans. It is so tempting sometimes, particularly when you eat out with friends.

Participant 11: Me being one remembering all my medications, including doctor appointments, especially that I am diabetic.

Participant 14: Maintaining positivity without being unrealistic about what lies ahead.

Participant 10: I have not told many people yet, but I am talking to my close family for support; my doctor has been really helpful in explaining things and creating a management plan.

Subtheme 5: Hopes, fears, and living with uncertainty

This sub-theme explored participants’ emotions regarding the future progression of chronic kidney disease (CKD). This subtheme shows that living with chronic diseases such as CKD may become an emotional burden. This highlights the participants' desire for control and their anxiety about potential limitations and future health complications. Some participants described this as follows:

Participant 15: By following my doctors’ recommendations, I hope I will be able to keep it at bay for as long as possible. My greatest fear is that I would have to go on dialysis or have a transplant.

Participant 12: I hope that my CKD will not deteriorate to the point where dialysis is required.

Participant 13: I worry about losing my ability to travel and participate in activities I love.

Participant 5: Despite the presence of CKD in me, I hope that one day I can live long enough with it. What I am afraid of is that I do not know what is in the future for us with this kind of illness.

Hopes, fears, and living with uncertainty" underscored the significant emotional burden associated with chronic kidney disease. Participants expressed a desire for control over their illness and a deep fear of future complications, including dialysis, or limitations in their activities. The uncertainty surrounding their condition fueled their anxieties, highlighting the need for comprehensive support that addresses both the physical and emotional aspects of living with CKD.

This qualitative study aimed to explore the diverse courses of chronic kidney disease) and to understand illness perspectives from patients fostering customized nursing approaches. The researchers conducted interviews in which four main themes and five sub-themes were identified. The idea of slow creep’ in chronic kidney disease (CKD) as an emerging theme reflects how the illness gradually affects patients’ lives over time. It also emphasizes their gradual decline and its impact. Such thoughts are supported by other studies that consider different trajectories at early stages when people live with CKD, thus revealing the various challenges faced by them during this period. For instance, James et al. [10] conducted a retrospective qualitative study aimed at understanding patients’ reported experiences, symptoms, outcomes, and treatment journeys with CKD. This investigation showed that it is important to take into account what individuals say about their own illness so as to appreciate its complexity. Du et al. examined self-management among those with CKD in addition to identifying several common challenges including dietary management as well coping strategies for comorbidities together with symptoms. Hence, there should be knowledge about the complete encounter of such patients, which entails a burden of signs, among others, such as psychosocial aspects; hence, providing comprehensive care will lead to better results for recipients. To improve the quality of life of patients and meet their distinct requirements, it is important for medical practitioners to consider the different experiences, barriers, and attitudes of people with CKD.

The subtheme "The range of experiences in early stage CKD" emphasizes the various ways individuals may navigate chronic kidney disease (CKD) during its initial phases. Early detection and intervention are crucial in managing CKD, as it is often asymptomatic in its early stages, leading many patients to be diagnosed only when the disease has progressed significantly [1]. This view is supported by several studies that explored various aspects of progression towards end-stage renal failure among people living with chronic kidney disorders during the initial phases. For example, Mcleland et al. [12] pointed out that diagnosis often occurs in advanced stages, where there may be irreversible renal lesions, thus underscoring the need for early detection and intervention to slow down the disease course [12]. Thus, prompt identification and management can alter outcomes among patients with CKDs. Furthermore, it was revealed that if a care program for early stage CKDs was put in place, then there would be a delay in the deterioration of kidney function, thereby showing great importance for proactive management in decelerating the advancement of diseases [13]. Therefore, recognizing dietary patterns up to prevention measures taken during the initial stages will enable care providers to recognize individual needs while addressing them so as to maximize outcome optimization among C.K.D patients.

The theme “Balancing hope and uncertainty’ presents a situation in which optimism is met with an unpredictable disease. This also addresses the sub-theme ‘Navigating a new reality” that comes with early stage CKD, where people must adapt themselves as per the different occurrences occasioned by this condition. Many studies support such notions, giving further insight into how to take care of patients and manage other aspects of the ailment itself, which demonstrates its dynamism even more. For instance, one should be capable of detecting CKDs early so that they can learn more about it and care for themselves thereafter to prevent re-infection [14]. In a similar vein, Levey et al. [15] discussed global health risks due to chronic kidney disease (CKD) and classified worldwide screening methods, indicating that prompt remedial steps in management are essential whenever worst scenarios occur from these ailments’ families. These actions combine hopefulness with unpredictability through alertness created while they tactically respond to any case related to managing patients affected by CKDs. In addition, Shabaka et al. [16] scrupulously addressed the most appropriate ways of managing chronic renal failure, such as controlling blood pressure, thereby explaining the need for a comprehensive handling approach. By integrating evidence-based interventions with proactive strategies, as well as patient-centeredness, ignorance will no longer be a barrier for individuals suffering from CKDs, thus leading to improved health outcomes.

In this study, the theme “Turning Point” signifies moments in illnesses that are very important when patients’ health status, forms of treatment, and general welfare can suddenly turn their course. This is supported by the subtheme “contributory factors, ” which explores how different factors affect these critical stages of the CKD journey, emphasizing how dynamic diseases can evolve into outcomes for individuals. Several articles add a lot to this focus area and shed more light on the different ways chronic kidney disease progresses, resulting from various determinants. For example, Tuttle et al., [17] investigated the clinical profile and risk factor associated with CKD in pediatric and adult populations with emphasis on early diagnosis and therapy should be employed so as to reduce its progression rate. Michishita et al. [18] and Wakasugi et al. [19] studied the relationship between lifestyle behaviors and the prevalence or incidence of CKD, focusing on unhealthy habits affecting its advancement among populations. These studies show how lifestyle changes contribute to CKD management as modifiable risk factors at key points in disease progression, necessitating targeted interventions to address these issues. Healthcare providers can better assist patients during critical times of managing their CKDs, thus improving healthcare delivery services to such patients and improving their quality of life.

The theme "CKD Progression Patterns” explores individuals’ journeys with chronic kidney disease and highlights its complexity. In line with this, the subtheme called “Hopes, Fears, and Living with Uncertainty” brings out emotions and thoughts around living with this condition. Many studies have been conducted that support these findings by examining different angles of chronic renal failure progression as experienced by the patients themselves. For example, Peng et al. [20] conducted a systematic review and meta-analysis on self-management interventions for CKD, emphasizing that patients need to be empowered to take care of themselves. This study also reflects on what people go through while trying to live healthily with CKD, thus indicating that it is important for individuals to have effective self-management strategies if they hope to survive such a condition. Additionally, Tuttle et al. [21] reported on diabetic kidney disease, whereby they focused mainly on cardiovascular disease management and glycemia measurement, thereby showing how complex caring for someone with CKD can become. Yan et al. [22] were concerned with slowing down renal failure progression, hence underlining early intervention as well as comprehensive treatment approaches as useful strategies for achieving this objective. Taken together, these investigations point out the challenges, but also hopes, fears, and uncertainties associated with having this health problem among people living with it at different stages of their lives. The overall idea behind the theme described here is that there are many sides to chronic kidney diseases; therefore, one should never look at them from only one perspective because they are multi-faceted in nature. Thus, addressing emotional aspects along physical dimensions during management might enable better outcomes for individuals who desire improved quality of life despite facing various difficulties. In context, recognizing the importance of early intervention, nurses can significantly impact Chronic Kidney Disease (CKD) by detecting and intervening early to potentially slow its progression. This patient-centered approach goes beyond just medical care. Nurses can provide crucial emotional support and education, addressing patients' anxieties and uncertainties. Additionally, connecting patients with support groups or social workers helps them manage the emotional burden and navigate the healthcare system effectively. Finally, empowering patients through shared decision-making fosters a sense of control and improves adherence to treatment plans, ultimately leading to better patient outcomes.

Implication on nursing practice

Complex cases have different patterns of progression in patients with chronic kidney disease (CKD). These are stages from which all other care is based and serve as a chance for nurses to improve outcomes since there are different presentations; hence, the one-size-fits-all concept does not work. Therefore, they create personalized care plans depending on each individual’s need and its natural course. However, methods such as group screening for risk factors such as previous renal failure and diabetes mellitus type II, and implementation of interventions informing about prognosis, among others, may discourage its progression. Specific issues in educational materials should also be addressed during the various phases of illness. For example, emotional counseling would help people with depression accompanied by rapidly fluctuating symptoms, or how to change modifiable risks ought to be taught to those whose signs take a relatively long time. Furthermore, nurses can play an important role in patient advocacy so that they can promote shared decision-making processes in treatment selection and facilitate access to appropriate services. By concentrating on the psychological ramifications of CKD, nurses would provide focused counselling towards an all-rounded approach to care for patients’ lives. Eventually, by including this knowledge about various CKD progression patterns into their work routines, nurses will be able to provide more efficient and compassionate individualized medical decisions thereby improving life quality among those living with CKD.

Limitations of the study

This qualitative study aimed at understanding CKD progression in Saudi Arabia has some limitations that make it difficult to generalize its findings. This sample size is very limited and may not be generalizable to the larger CKD population in Saudi Arabia. In addition, only stages 1 and 2 were considered, indicating that more complicated stages were not included. However, using the snowball sampling technique subsequent to purposive sampling can lead to bias, as participants who are recruited from social networks might not represent the entire population. In addition, the interview time was constrained between 45 minutes and an hour, which may have limited how much of their experiences and feelings could be captured by these researchers. Moreover, the lack of prior knowledge of this condition among interviewers could influence the depth of their questioning and exploration. Finally, the findings cannot be generalized to other healthcare settings in Saudi Arabia, since it was conducted only in one outpatient department. These limitations suggest that future studies need larger samples including different respondents with varying CKD stages and employing various qualitative methods to ascertain greater insights into CKD patterns in Saudi Arabian patients.

With the application of thematic analysis in the interviews, four major themes that reflected the experiences of patients with early stage CKD were identified. “Slow Creep,” brings out different ways through which individuals encounter this phase of illness. This theme goes into further expounding this range of occurrences. The second theme, “Balancing Act of Hope and Uncertainty,” spotlights hope to manage illness and uncertainty about tomorrow. This progression is additionally reviewed in the third sub-theme, highlighting how one lives with CKD in a new light. The third theme, “Turning Point,” brings to light a crucial occurrence in the disease trajectory, while its subsequent sub-theme looks at some factors contributing to that shift point. Finally, CKD Progression Patterns (fourth theme) deal with difficulties encountered when managing CKD, alongside emotional implications related to living with uncertainties. Two other sub-themes were also included: challenges faced when dealing with CKD, hopes fears, and general insecurities surrounding it. Although these themes provide a framework for understanding the early stage CKD patient experience, there is a need for further research in order to make specific conclusions based on this study.

Acknowledgement

The authors would like to acknowledge the Scientific Research Deanship of University of Hail - Saudi Arabia through project number RG-23 040.

Authors’ contributions

R.S. A.A., E.R., J.B conceptualized the study; A.A, S.M. R.M. B.E.A. project administration and funding acquisition. R.M.J, J.B. R.M and, M.A., B.E.A. analysed and interpreted the data and equally contributed to writing the manuscript. All authors reviewed the manuscript.

Funding

This research has been funded by Scientific Research Deanship at University of Hail - Saudi Arabia through project number RG-23 040.

Availability of data and materials

The datasets generated in this current study are available from the corresponding author on reasonable request.

Ethics approval and consent to participate

Ethical approval was granted by the Institutional Review Board of the University of Ha’ il (H-2023-0134). The research team confirmed that all methods were performed in accordance with relevant guidelines and regulations. Informed consent was obtained from all subjects.

Consent for publication

Not Applicable.

Competing interests

We confirm that all authors declare no competing interests.

Author details

¹College of Nursing, University of Hail, Hail Saudi Arabia

²King Khalid Hospital, Ministry of Health, Hail Saudi Arabia

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06 Sep, 2024
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04 Sep, 2024
First submitted to journal
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You are reading this latest preprint version

A Qualitative Exploration on Understanding Progression Patterns and Nursing Implications of Chronic Kidney Disease

Status:

Version 1

Abstract

Introduction

Methods

Research Design:

Setting/ Participants

Data collection

Ethical consideration

Data Analysis

Results

Theme 1: Slow creep

Theme 2. Balancing hope and uncertainty

Subtheme 2: Navigating a new reality

Theme 3. Turning point

Subtheme 3: Contributory factors

Theme 4. CKD progression patterns

Subtheme 4. Challenges in managing CKD

Subtheme 5: Hopes, fears, and living with uncertainty

Discussion

Implication on nursing practice

Limitations of the study

Conclusion

Declarations

References

Additional Declarations

Status:

Version 1