Young Adults’ Perspectives on Living with Kidney Failure: a Systematic Review and Thematic Synthesis of Qualitative Studies

Introduction
Young adults fare worse than younger adolescents or older adults on a broad range of health indicators. Those with a chronic illness such as renal failure are a particularly vulnerable group, who experience poor outcomes compared to both children and older adults. Understanding how being in receipt of renal replacement therapy (RRT) affects the lives of young adults might help us to better prepare and support these individuals for and on RRT, and improve outcomes. This study aimed to synthesize research describing young adults’ experiences of the psychosocial impact of kidney failure and RRT.

Design
A systematic literature review identified qualitative research reporting the perspectives of 16-30 year olds receiving RRT on the psychosocial impact of renal failure. Electronic databases (including Medline/EMBASE/PsycINFO/ASSIA) were searched to November 2017 for fulltext papers. The transparency of reporting of each study was assessed using the COREQ framework. Quality was assessed using the CASP qualitative checklist. An inductive thematic synthesis was undertaken.

Participants
7 studies from 5 different countries were included, comprising 123 young adults receiving RRT.

Results
Comprehensiveness of reporting was variable: studies reported 9 to 22 of the 32 COREQ checklist items.

Three global themes about the impact of kidney failure on young adults were identified: 1) Difference desiring normality; 2) Thwarted or moderated dreams and ambitions; 3) Uncertainty and liminality. These reflected five organising themes: i) Physical appearance and body image; ii) Activity and participation; iii) Educational disruption and underachievement; iv) Career ambitions and employment difficulties; and v) Social isolation and intimate relationships.

Conclusions
Across different countries and different healthcare settings, young adults on RRT experience difference and liminality, even after transplantation. Tailored social and psychological support is required to allow young adults to experience wellness whilst in receipt of RRT, and not have life on hold.