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The global prevalence of chronic kidney disease (CKD) has continued to rise over time. Pharmacological therapy is the mainstay of conventional CKD treatment; however, many CKD patients find it difficult to adhere to their medication regimen.
To systematically evaluate and compare the effects of various self-management support strategies for patients with CKD.
We searched PubMed, Embase, The Cochrane Library, Web of Science, and Scopus to identify quasi-randomized and RCTs comparing the effectiveness of different self-management support strategies in CKD patients, The search spanned from database inception to June 24, 2025. Two reviewers independently screened the literature, extracted information, assessed the quality of studies, and we performed analysis using RevMan 5.0 and STATA 14.0 software.
Eighty-one studies were included, examining 10 strategies. Compared to conventional interventions, face-to-face combined tele-guidance, group visits, tele-guidance, and multi-component structured interventions significantly improved patients' self-efficacy. Surface under the cumulative ranking curve (SUCRA) of different self-management support strategies influencing self-efficacy ranked in the top three were face-to-face combined tele-guidance, group visits and tele-guidance. Empowerment interventions, cognitive behavioral therapy (CBT) and tele-guidance enhanced quality of life compared to conventional interventions. The SUCRA for quality of life ranked highest for empowerment, CBT and face-to-face combined tele-guidance. Additionally, we found that these strategies were beneficial in improving patients' blood pressure, IDWG, renal disease knowledge, and self-management.
The study offers evidence on effective self-management support strategies for CKD patients, highlighting face-to-face combined tele-guidance might be the most effective intervention for increasing self-efficacy, while empowerment might be the most effective intervention for increasing quality of life in CKD patients. These findings can help healthcare providers design better programs to improve patient outcomes. However, more high-quality RCTs are needed to confirm findings.
PROSPERO: CRD42024596581
by Salman H. Choudhry, Keegan D’Mello, George Kim, Robin Mackin, Amrit Kirpalani
The study examines the influence of Asian sub-ethnic identity on the experiences of pre-medical students in the United States and Canada, aiming to understand how early interactions with the medical education system shape their pursuit of medicine. The researchers analyzed 132 discussion threads from popular online premedical school forums between June 2018 and 2023. The Asian Critical Theory framework guided the analysis along with cyclical inductive coding. Two major themes emerged: the homogenization of diverse Asian sub-ethnicities and external pressure related to sociocultural values. Terms like “over-represented minorities” contributed to the perception of Asians as a monolithic group, while expressions such as “Asian Parents” highlighted unique familial expectations. Non-Asian users often dismissed these barriers, reinforcing the model minority myth. The study emphasizes the negative consequences of framing Asians as a homogenous group in medical school admissions policies, perpetuating stereotypes, and overlooking the diversity within Asian sub-ethnic communities. The term “overrepresented” is critiqued for its role in homogenizing Asian identities and undermining the complexity of their experiences. These findings highlight the need for greater recognition of the nuanced challenges faced by Asian sub-ethnic medical trainees and the importance of dismantling stereotypes in medical education.
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