The review of the related literature provides the researchers a basis for conducting

the study if there are other researches relevant to this study or related to the
content of this study and the past research conducted.

The reserachers can identify and gather differently related and relevant literatures
underfeed primary and secondary sources and electronic sources such as reserach
journals, surveys, statistics, reliable websites and others.

Chronic Kidney Disease (CKD) is a prevalent health condition that affects lots of
individuals worldwide. In the Philippines, particularly in Tabuk City, Kalinga, CKD has
been identified as a significant public health concern. This review of related
literature aims to provide a comprehensive overview of the lifestyle choices,
challenges, and coping mechanisms among CKD patients in Tabuk City, Kalinga,
drawing on existing research in the field of nursing and related disciplines.

Lifestyle Choices and Chronic Kidney Disease:

Dietary Habits and Nutritional Management

Dietary choices play a pivotal role in managing CKD. Research by(Fouque et al. 2017)
Dietary Protein Intake and Chronic Kidney Disease emphasizes the importance of
adhering to dietary restrictions, such as controlling protein intake, managing
phosphorus and potassium levels, and maintaining adequate hydration. This
highlights the challenges faced by CKD patients in making substantial changes to
their eating habits. Actual dietary protein consumption in CKD patients remain
substantially higher than the recommendations for LPD. Notwithstanding the
inconclusive results of the Modification of Diet in Renal Disease (MDRD) study, the
largest randomized controlled trial to examine protein restriction in CKD, several
prior and subsequent studies and meta-analyses including secondary analyses of the
MDRD data appear to support the role of LPD on retarding progression of CKD and
delaying initiation of maintenance dialysis therapy. LPD can also be used to control
metabolic derangements in CKD. Supplemented LPD with essential amino acids or
their keto-analogs may be used for incremental transition to dialysis especially in
non-dialysis days. An LPD management in lieu of dialysis therapy can reduce costs,
enhance psychological adaptation, and preserve residual renal function upon
transition to dialysis. Adherence and adequate protein and energy intake should be
ensured to avoid protein-energy wasting.

Physical Activity and Exercise

Regular physical activity can positively impact CKD patients. A study by (Painter et al.
2019) The association of physical activity and physical function with clinical
outcomes in adults with chronic kidney disease underscores the benefits of exercise
in improving cardiovascular health and overall well-being for CKD patients. However,
this also reflects the challenge of maintaining an exercise routine while coping with
the fatigue and physical limitations associated with CKD. The strength of the
evidence presented should strongly motivate a focus of treatment on assessing and
improving physical activity and physical function as part of routine patient-centered
management of persons with CKD. Physical activity interventions are warranted
because patients with CKD, regardless of age, have a high prevalence of low physical
functioning and frailty that is similar to or higher than the general population of
elderly adults; physical activity, physical function, and performance are strongly
associated with all-cause mortality; and exercise training and exercise counseling
have been shown to improve measures of physical functioning.

Challenges faced by Chronic Kidney Disease Patients:

Chronic Kidney Disease (CKD) poses several significant challenges for patients in the
Philippines, impacting their overall quality of life and well-being. Nursing research in
the Philippines has shed light on the specific challenges faced by CKD patients in this
context. Below are some of the key challenges documented in nursing research:

Emotional and Psychological Challenges

CKD often leads to emotional distress, anxiety, and depression. The work of (Griva et
al. 2018) Anxiety and depression in patients with end-stage renal disease: impact
and management challenges discusses the psychological struggles faced by CKD
patients and Implementing systematic distress screening in routine clinical care
would be an important first step, which should be performed in conjunction with
providing appropriate interventions.. Patients with CKD often have psychiatric
difficulties in the form of depression and anxiety. Existing literature sheds light onto
the specific impacts and mechanisms that psychiatric difficulties can influence CKD
treatment and outcomes. If overlooked, these psychiatric comorbidities can affect
the patient’s treatment prognosis and mortality. There is an ever-increasing need for
physicians to address and treat patients with CKD that present with psychiatric
comorbidities.

The high prevalence rates of depression and anxiety in patients with CKD as
compared to other chronic diseases is of an important concern. It is unfortunate that
compared to other chronic illnesses such as coronary heart diseases and cancers, the
study of CKD and related psychological disorders are far less extensive. Existing
epidemiological studies have revealed important insights and factors that contribute
to the development of depression and anxiety in patients with CKD. Patients with
certain social, psychological, and clinical characteristics were found to be more
prone to falling into depression. These associations provide practitioners vital
indicators to identify and assess patients for psychiatric disorders more efficiently.

Limited Access to Healthcare

Many CKD patients in the Philippines face challenges in accessing healthcare due to
economic constraints and geographic barriers. Research by (Perez et al. 2018)
highlights the financial burden associated with CKD management, including the cost
of medications, dialysis, and transportation to healthcare facilities.

Dialysis Availability and Affordability

The cost of CKD management, especially renal replacement therapy like
hemodialysis or kidney transplantation, can be exorbitant for many Filipinos. The
financial burden is a significant challenge, as most patients struggle to afford the
expenses associated with their treatment (Pajimna et al 2023) Gaps and challenges
in the provision of treatment for patients with end-stage renal disease: perspectives
from the Philippines

In the Philippines, its prevalence is 35.94%, which is much higher than estimated
global rates. Aside from its contribution to mortality, the growing burden of CKD is
also illustrated by its associated financial costs. Locally, 94% of end stage renal
disease (ESRD) patients are undergoing center-based hemodialysis, 4% are on
peritoneal dialysis and only 2% had kidney transplantation. Despite Kidney
Transplantation being the gold standard treatment for CKD, Hemodialysis is still
preferred by most Filipino patients due to transplant costs, low organ donations, lack
of capable infrastructures, and long term immunosuppression therapy.
The Philippines depends on the national health insurance program, PhilHealth, which
ideally guarantees all citizens automatic enrollment pursuant to the Universal Health
Care Law of 2019. However, data of registered beneficiaries from 2018 to 2021
observed geographical discrepancies, with a few remote provinces noted to have
coverages of only 52% and below. There are also some gaps in provision of financial
assistance to the beneficiaries. PhilHealth covers the costs of Hemodialysis,
Peritoneal dialysis and Kidney Transplant in varying degrees. However, most patients
still choose Hemodialysis over Peritoneal dialysis, despite better coverage of
Peritoneal dialysis in the past. It was only in June 2023 when PhilHealth's coverage
was expanded to 156 Hemodialysis sessions to fully cover the recommended thrice-
weekly annual treatments. This is an improvement from the 45, 90, and 144
Hemodialysis sessions previously amended in years 2013, 2015, and 2020,
respectively, wherein patients had to resort to twice-weekly sessions or pay out-of-
pocket.

In general, preference for center-based Hemodialysis treatments are due to

supervised care, patient burnout, family burden, and lack of confidence in self-
treatment. However, one strategy to minimize the healthcare workforce strain and
to reduce the economic costs of ESRD is increasing the use of home-based dialysis
modalities, be it Peritoneal dialysis or home-based Hemodialysis. Hemodialysis
centers are also more concentrated in urbanized cities, hence home-based
treatments would be ideal for the Philippines, where geographical access for
healthcare is a problem, especially in rural areas. Advantages of home-based dialysis
also include lower costs from manpower and infrastructures and less patient
infection exposure.

Dietary and Medication Adherence

Adhering to dietary restrictions and medication regimens can be difficult for CKD
patients. Research by Niraj Beerendrakumar et al. (2018) “Dietary and Fluid Regime
Adherence in Chronic Kidney Disease Patients” suggests that patient education and
counseling are essential to help patients understand and comply with these lifestyle
changes.
Adherence to the dietary and fluid components is essential to reduce the morbidity
related to renal dysfunction. This study report suggests, in spite of nutritional
counseling there is considerable proportion of patients have deviated from dietary
guidelines which can be minimized with reinforcing counseling by nurses and other
health care providers. In hemodialysis patients, the nurses and other health system
personnel should identify strategies to improve communication with reinforcing
dietary counseling to patients and family members to help them to adhere with
treatment regimen, and dietary guidelines.

Limited Health Literacy

Many CKD patients have limited health literacy, making it challenging for them to
understand their condition and treatment options. Nursing research by Abukari
Kwameet al. (2021) A literature-based study of patient-centered care and
communication in nurse-patient interactions: barriers, facilitators, and the way
forward emphasizes the importance of patient education and simplified
communication, Effective communication is an essential factor in nurse-patient
interactions and a core component of nursing care. When communication in the
nurse-patient dyad is patient-centered, it becomes therapeutic. It allows for trust
and mutual respect in the care process, thereby promoting care practices that
address patients’ and caregivers’ needs, concerns, and preferences. We have
identified the barriers and facilitators of patient-centered care and communication
and proposed a person-centered care and communication continuum (PC4 Model) to
demonstrate how patient-centered communication intersects with patient-centered
care.

Transportation Issues
Transportation to and from healthcare facilities can be a significant challenge for
CKD patients, particularly in rural areas.

Coping Mechanisms Among CKD Patients:

Social Support
Family and peer support are essential coping mechanisms for CKD patients. A
qualitative study by Christina Seery (2022) The psychosocial needs of patients who
have chronic kidney disease without kidney replacement therapy: a thematic
synthesis of seven qualitative studies emphasizes that the present review aimed to
synthesise qualitative research on the experiences of patients who have CKD without
KRT, to provide additional insight into their potential psychosocial needs. Some
patients reported finding information about CKD confusing or inadequate. Peers are
identified as a helpful resource and could be capitalised on for an educational group
intervention. Patients can feel conscious of burdening their friends and family. The
review also observed several concerns for patients regarding the psychological
effects of CKD without KRT. Patients appeared to feel helpless, as if they had lost
control, had challenges adjusting and were fearful of the future. Therefore, the
review highlights several psychosocial needs for patients who have CKD without KRT
and potential areas for interventions.

Patient Education and Self-Management

Patient education programs are crucial in empowering CKD patients to manage their
condition effectively. The work of Brendan P. Cassidy et al. (2018) Barriers to
Education and Shared Decision Making in the Chronic Kidney Disease Population: A
Narrative Review highlights the significance of education in improving self-
management and decision-making regarding lifestyle choices. “Patient-centered
care” needs to be the framework of every physician-patient interaction. It is through
screening, communicating and engaging patients with CKD in their health care, that
clinicians will be given the tools to overcome many patient-level barriers to effective
education and SDM. Clinicians must be willing to manage the entire person, not just
their medical problems, which requires the expertise of a multidisciplinary team.

Patients with CKD have many different characteristics, perspectives, and lived
experiences that impact their treatment decisions. These include social influences,
values and beliefs, level of comprehension, need for autonomy, and
sociodemographics. These factors influence the way patients receive education and
make medical decisions, which is why clinicians must value and participate in SDM to
navigate potential conflicts. Through the recommendations laid out in this narrative
review, the number of informed patients can be maximized, allowing SDM involving
RRT to be fulfilled.

Counseling and Psychological Support

Psychoeducation and counseling interventions have shown promise in helping CKD
patients cope with the emotional challenges they face. The study by Serena Barello
et al. (2022) The effect of psychosocial interventions on depression, anxiety, and
quality of life in hemodialysis patients: a systematic review and a meta-analysis
suggests that psychosocial interventions are promising interventions for improving
psychological well-being in adults undergoing HD. Psychosocial interventions, such as
psychological support or relaxation-based therapy, may reduce depression and
anxiety in adults undergoing HD. Preliminary evidence suggests that there may be a
benefit of psychosocial interventions on the quality of life for adults undergoing HD.

Cultural Perspectives
It is important to consider cultural and regional factors when examining lifestyle
choices, challenges, and coping mechanisms among CKD patients in Tabuk City,
Kalinga. The cultural norms, beliefs, and healthcare access in this region may
influence the unique experiences of CKD patients.

Nursing research in the Philippines is vital in understanding the unique challenges

faced by CKD patients in this City and in developing targeted interventions and
policies to improve the quality of care and the overall well-being of CKD patients.
Addressing these challenges requires a multidisciplinary approach involving
healthcare professionals, policymakers, and the community.