Navigating Renal Dietary Guidelines in ESKD and Obesity

Background: Adherence to renal dietary guidelines, which includes monitoring dietary intake of sodium, potassium, phosphorus and fluids, and consuming sufficient protein and fiber, may prevent hospitalizations and mortality in kidney failure. Forty percent of individuals with ESKD are estimated to have obesity (BMI ≥ 30 kg/m 2 ) and may be advised to lose weight for kidney transplantation eligibility. Although social support influences chronic disease management, mechanisms linking social support and renal diet adherence in ESKD and obesity remain unclear. Methods: We conducted an interpretive phenomenological analysis of in-depth interviews with 40 English-speaking adults with ESKD and obesity, recruited using purposive sampling for geographic and demographic diversity. We coded transcripts with interdisciplinary team members, used analytical memos and matrices to compare cases. We grouped participants by self-reported levels of perceived social support and dietary adherence. Results: Twenty-three participants were female; 35% identified as Black/African American and 13% as Hispanic/Latino. Narratives highlighted the socially isolating nature of being an ESKD patient. Fatigue, limited mobility, and long treatment times were seen as barriers to cooking and grocery shopping. Twenty-three (58%) reported high levels of perceived social support, with instrumental support from household members being the most common. Nineteen participants (48%) described high levels of perceived renal diet adherence, characterized by reading nutrition labels, cooking, meal planning, and using kidney-friendly substitutions. Three main findings emerged: 1) household members are the primary sources of social support that facilitate dietary behaviors, 2) gender and social roles, especially caregiving and accommodating household food preferences, influence whether existing social networks are leveraged to support dietary adherence, 3) the availability of social support is dynamic and its loss prompts convenience behaviors that jeopardize dietary adherence. Conclusions: Social support plays a central role in diet-related behaviors of individuals with ESKD and obesity. Interventions that engage household members have the potential to promote dietary adherence.