Socio-demographic, psychological health and lifestyle outcomes in young adults on renal replacement therapy: systematic review

Background and objectives: Young adults receiving renal replacement therapy (RRT) face additional challenges in life. The impact of established kidney failure on young adulthood is uncertain. We aimed to establish the psychosocial and lifestyle status of young adults receiving RRT. Design, setting, participants, and measurements: Systematic review and meta-analysis of 16-30 year olds receiving RRT, compared with the general population. We selected randomized controlled trials, cohort or cross-sectional studies without language restriction and extracted proportions of socio-demographic and lifestyle outcomes; or validated psychological health tests producing quality of life, wellbeing and self-esteem scores. We undertook random-effects meta-analysis. Results: 60 studies of 15575 participants. Studies were largely single center cross-sectional studies of those transplanted in childhood. Compared to healthy peers, young adults on RRT had lower quality of life, worse for dialysis patients (7 studies, standardized mean difference (SMD) -1.01, 95% confidence interval (CI) -1.32, -0.70) compared to transplant (9 studies, SMD -0.42, 95% CI -0.64, -0.20). They were more likely to be unemployed (7 studies, relative risk (RR) 1.89, 95% CI 1.47, 2.44) and to live in the family home (2 studies, RR 1.84, 95% CI 1.40, 2.43). They were less likely to be married or have a partner (4 studies, RR 0.71, 95% CI 0.53, 0.95). Higher education (3 studies, RR 1.05, 95% CI 0.73, 1.51), alcohol abstinence (3 studies, RR 1.96, 95% CI 0.84, 4.67) and smoking status (2 studies, RR 0.72, 95% CI 0.36, 1.44) did not differ. Results were limited by high heterogeneity and a small evidence base, biased towards surviving patients.