Understanding Patients’ Experiences and Adherence Challenges with Dietary and Fluid Restriction in End-Stage Kidney Disease: A Qualitative Study

Purpose: Dietary and fluid restrictions are essential for individuals with end-stage kidney disease across treatment modalities, including hemodialysis, peritoneal dialysis, and non-dialysis management. However, adherence to these restrictions remains suboptimal, and limited evidence exists regarding how individuals across different treatment stages interpret and manage these requirements in daily life. This study aimed to explore patients’ lived experiences of dietary and fluid restrictions across these groups and to identify factors associated with adherence behaviors. Methods: A descriptive qualitative study was conducted between April and May 2024 in China. Six focus group interviews were held with 40 individuals with ESKD, including 14 receiving hemodialysis, 14 undergoing peritoneal dialysis, and 12 managed without dialysis, aged 23– 76 years. All interviews were audio-recorded, transcribed verbatim, and analyzed inductively using thematic analysis to identify key themes and subthemes. Results: Six themes and 14 subthemes were identified and organized using the Health Belief Model: perceived susceptibility (interpreting the absence of symptoms as low risk, optimistic bias); perceived severity (experiencing physical discomfort and functional limitation, anticipating burden on family and daily life); perceived benefits (perceiving health and economic benefits, strengthening responsibility and sense of control); perceived barriers (experiencing psychological burden and behavioral conflict, navigating social and situational constraints, facing information complexity and uncertainty); self-efficacy (modifying daily dietary habits, emphasizing the role of self-discipline, using monitoring and adjustment strategies); and cues to action (responding to health deterioration as a turning point, drawing on multiple sources of support). Conclusion: Adherence to dietary and fluid restrictions in end-stage kidney disease is shaped by patients’ interpretations of risk, embodied and social experiences, and negotiation of daily dietary demands. These processes occur within cultural and informational contexts where emotional burden, uncertainty, responsibility, and social support interact. Understanding these mechanisms may inform more patient-centred dietary care. Keywords: end-stage kidney disease, dietary adherence, fluid restriction, qualitative study, health belief model