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Background <p>Depression and anxiety are common in chronic kidney disease (CKD) and worsen clinical outcomes. Psycho-behavioural interventions offer a promising, non-pharmacological approach. However, most evidence comes from people with kidney failure with distinct treatment needs, limiting relevance to earlier stages of CKD, where timely support may enhance self-management and slow progression. This systematic review evaluates the effectiveness of psycho-behavioural interventions in adults with CKD without dialysis or transplantation.</p> Methods <p>We searched MEDLINE, EMBASE, PsycINFO, Cochrane Central, and Web of Science (inception–March 2025) for randomised controlled trials (RCTs) testing psycho-behavioural interventions in adults with CKD (not on kidney replacement therapy), with depression and/or anxiety as primary or secondary outcomes. Risk of bias (RoB-2) and certainty of evidence were assessed. Given methodological heterogeneity across studies, vote counting by effect size and narrative synthesis were applied. PROSPERO: CRD42024515733.</p> Results <p>Five RCTs (<i>N</i> = 631) met the inclusion criteria, evaluating cognitive behavioural therapy, self-efficacy training, mindfulness-based stress reduction, and physical activity, delivered digitally, by phone, or in person. Moderate-certainty evidence showed consistent improvements (100% positive) in self-efficacy and physical function. Low-certainty evidence indicated 100% positive effects on self-management, while findings for depression were mixed (67% positive), with one study reporting worsening symptoms. Evidence for anxiety, fatigue, quality of life, and kidney function was inconclusive due to high inconsistency and imprecision.</p> Conclusion <p>Psycho-behavioural interventions may enhance self-efficacy, self-management, and physical function in CKD. However, evidence for mental health and kidney outcomes remains limited. Robust, long-term RCTs with tailored, multi-component approaches are needed to support integration into kidney care.</p> Graphical Abstract <p></p>

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Do psycho-behavioural interventions improve mental and physical health in chronic kidney disease? A systematic review of randomised controlled trials

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年9月10日

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  • Pooja Schmill,
  • Natasha Seaton,
  • Sharlene Greenwood,
  • Joanna L. Hudson,
  • Emily McBride,
  • Sam Norton,
  • Joseph Chilcot

摘要

Background

Depression and anxiety are common in chronic kidney disease (CKD) and worsen clinical outcomes. Psycho-behavioural interventions offer a promising, non-pharmacological approach. However, most evidence comes from people with kidney failure with distinct treatment needs, limiting relevance to earlier stages of CKD, where timely support may enhance self-management and slow progression. This systematic review evaluates the effectiveness of psycho-behavioural interventions in adults with CKD without dialysis or transplantation.

Methods

We searched MEDLINE, EMBASE, PsycINFO, Cochrane Central, and Web of Science (inception–March 2025) for randomised controlled trials (RCTs) testing psycho-behavioural interventions in adults with CKD (not on kidney replacement therapy), with depression and/or anxiety as primary or secondary outcomes. Risk of bias (RoB-2) and certainty of evidence were assessed. Given methodological heterogeneity across studies, vote counting by effect size and narrative synthesis were applied. PROSPERO: CRD42024515733.

Results

Five RCTs (N = 631) met the inclusion criteria, evaluating cognitive behavioural therapy, self-efficacy training, mindfulness-based stress reduction, and physical activity, delivered digitally, by phone, or in person. Moderate-certainty evidence showed consistent improvements (100% positive) in self-efficacy and physical function. Low-certainty evidence indicated 100% positive effects on self-management, while findings for depression were mixed (67% positive), with one study reporting worsening symptoms. Evidence for anxiety, fatigue, quality of life, and kidney function was inconclusive due to high inconsistency and imprecision.

Conclusion

Psycho-behavioural interventions may enhance self-efficacy, self-management, and physical function in CKD. However, evidence for mental health and kidney outcomes remains limited. Robust, long-term RCTs with tailored, multi-component approaches are needed to support integration into kidney care.

Graphical Abstract