The perspectives of young adults on the psychosocial impact of renal failure: a thematic synthesis of qualitative studies

Background: There is limited research on the impact of renal failure on the non-medical aspects of young adults’ lives. This study aimed to describe young adults’ experiences of the psychosocial impact of being in receipt of renal replacement therapy (RRT). Methods: This systematic review synthesizes qualitative studies investigating the perspectives of young adults (aged 16–30 years) on the impact of renal failure on the psychosocial aspects of their lives. Electronic databases were systematically searched to August 2016 for full-text qualitative studies without language restriction. The transparency of reporting of each study was assessed using the Consolidated Criteria for Reporting Qualitative Health Research (COREQ) framework, and inductive thematic synthesis was then undertaken. Results: 7 studies were included, comprising 123 young adults receiving RRT. The studies were from 5 different countries. Comprehensiveness of reporting was variable, with studies reporting 9 to 22 of the 32 possible items included in the COREQ checklist. Only one study was accompanied by an interview topic guide. Three global themes about the psychosocial impact of renal failure on young adults were identified: (1) Uncertainty and liminality; (2) Difference – desiring normality; and (3) Thwarted or moderated dreams and ambitions. These reflected five organising themes: (i) Physical appearance and body image; (ii) Activity and participation; (iii) Educational disruption and underachievement; (iv) Precarious employment; and (v) Social isolation and relationship difficulties. Conclusions: Young adults report that renal failure impacts on their ambitions and life-goals, and their capacity and opportunities to achieve them. They report an impact on the ability to form and maintain intimate relationships, and to achieve goals regarding parenting and parenthood. Themes were similar across different countries, and different forms of RRT.