Behaviour-Change Nursing Package Tied to Better Diet Adherence in Non-Dialysis Kidney Patients

A nursing programme built around behaviour change theory was associated with better dietary adherence and improved nutritional markers in people with chronic kidney disease who are not yet on dialysis, according to a retrospective observational study published in Frontiers in Public Health. The research, conducted at Wuxi People's Hospital Affiliated to Nanjing Medical University in China, compared routine nursing care with an intensive support package informed by the Behaviour Change Wheel (BCW) framework. The study analysed the clinical and nursing records of 57 non-dialysis chronic kidney disease patients admitted between June 2022 and June 2023.

All patients met predefined inclusion and exclusion criteria. Because the analysis was retrospective and non-randomized, patients were classified according to the nursing intervention documented in their records: 27 patients who had received routine nursing formed the control group, while 30 patients who had received the BCW-informed intensive nursing support package formed the observation group. This design means the two groups were not randomly assigned, and the findings reflect associations documented in records rather than the results of a controlled trial.

The researchers examined a broad set of outcomes. Nutrition-related indicators included serum albumin, prealbumin, transferrin and body mass index. Renal function was tracked using blood urea nitrogen, serum creatinine and cystatin C. Self-reported dietary adherence was assessed with an adapted Renal Adherence Behaviour Questionnaire, and the team also measured quality of life and reported nursing satisfaction.

Before the intervention, the two groups were statistically comparable. There were no significant differences in nutrition-related indicators, renal function indicators, questionnaire scores or quality of life, with all comparisons showing P values above 0.05. This baseline equivalence is important for interpreting the after-intervention differences, although it cannot rule out all sources of confounding in a non-randomized design.

After the intervention, the observation group showed significantly higher albumin, prealbumin and body mass index than the control group, with P values below 0.05. The difference in transferrin, however, did not reach statistical significance, with a reported P value of 0.169. This mixed pattern suggests that the behavioural intervention was associated with improvements in several, but not all, of the nutritional markers measured.

The renal function results were similarly inconsistent. Blood urea nitrogen was significantly higher and cystatin C significantly lower in the observation group after the intervention, while serum creatinine was numerically higher in that group but the between-group difference fell just short of statistical significance at P = 0.054. The reported findings indicate inconsistent changes among renal function-related markers, and the clinical meaning of divergent movements in these markers in a retrospective comparison is not established by this study.

Where the results were most consistent was in patient-reported behaviour. After the intervention, the observation group recorded higher scores on the adapted Renal Adherence Behaviour Questionnaire, indicating greater self-reported dietary adherence. The study's limitations are substantial and should temper interpretation.

The sample was small, with 57 patients in total, and the retrospective, non-randomized design means that patients receiving the intensive package may have differed from controls in ways the records did not capture. The final, formatted version of the article had not yet been published at the time of this report, so full details of the intervention protocol, follow-up duration and statistical adjustments were not available in the source material. The authors also state that the claims expressed are solely their own and do not necessarily represent those of their affiliated organizations, the publisher or the editors.

Even with those caveats, the association between the BCW-informed package and higher dietary adherence scores, alongside improvements in albumin, prealbumin and body mass index, is a signal that would need testing in larger, randomized and multicentre trials. Until such trials are done, the results should be read as hypothesis-generating evidence from a single hospital's records rather than proof of clinical benefit.

Subject of Research: Behaviour change theory-informed early rehabilitation nursing and patient compliance in non-dialysis chronic kidney disease

Article Title: Associations of BCW-informed early rehabilitation nursing with patient compliance and related outcomes in non-dialysis chronic kidney disease patients

Article References: Zhou, Y., Cao, X., Xu, X., Xu, L., Li, X., & Xu, Q. (2026). Associations of BCW-informed early rehabilitation nursing with patient compliance and related outcomes in non-dialysis chronic kidney disease patients. Frontiers in Public Health, 14, Article 1861842. https://doi.org/10.3389/fpubh.2026.1861842

Image Credits: AI Generated

DOI: 10.3389/fpubh.2026.1861842

Keywords: chronic kidney disease, behaviour change wheel, early rehabilitation nursing, dietary adherence, non-dialysis CKD, nutritional status, renal function, patient self-management, retrospective study, nursing intervention, Associations, BCW-informed