Insights into the experiences of people living with chronic kidney disease and obesity participating in a randomized controlled weight loss trial: A qualitative study.

BACKGROUND

Low energy diets (LEDs) (800-1200 kcal/day) can lead to 10-15 kg weight loss and diabetes remission. LEDs are now being explored for managing obesity in chronic kidney disease (CKD). Understanding patient experiences and perspectives of LED programs is essential for planning large-scale trials and to inform translation into clinical practice.

OBJECTIVE

To describe participants' experiences and perspectives of being involved in a randomized controlled trial (RCT) for weight loss involving an LED intervention or usual care (UC).

DESIGN

A qualitative description approach was followed using semi-structured interviews to collect data.

PARTICIPANTS

/setting Telephone interviews were conducted with 25 adults living with stages G1-3b CKD and a body mass index >30 kg/m2 from the SLOW-CKD feasibility RCT, in which participants had been randomized 1:1 to either an LED group or UC. Interviews explored participants' experiences and perspectives of following an LED with weight loss support, or receiving UC, and participating in a weight loss RCT.

DATA ANALYSIS: Interviews were audio recorded, transcribed verbatim and analyzed using reflexive thematic analysis.

RESULTS

Five themes were generated which highlighted: the longstanding battle with weight management and health experienced by people living with CKD and obesity; the value of a trusted study team and patient centered trial design; the role of support, persistence and personalized routines in developing new habits on an LED; the need to navigate individual challenges, motivations and preferences; and the benefits of the LED beyond weight loss. After initial challenges, LED participants adapted and were pleased with their commitment and success, noting improvements in kidney function, eating habits, diet quality and physical capacity. Several UC participants expressed disappointment and a sense of missed opportunity.

CONCLUSIONS

The study highlights the challenges faced by adults living with CKD and obesity. Provision of individualized support from trusted healthcare professionals can enhance participant experiences of LED interventions for adults with CKD and obesity. Findings support LED use in clinical practice and further research on its effectiveness in slowing CKD progression. Future weight loss trials should balance scientific rigor with strategies like 2:1 randomization, wait-list controls, or post-trial weight loss options to reduce randomization disappointment.