14 education about CKD play a role[34–36]. In stage 2 and 3, CKD often comes with co-morbidities, such as diabetes and hypertension, heightening the risks of complications and symptoms. In stage 4, there is a severe reduction in kidney function, leading to significant complications. The final stage, End-Stage Renal Disease (ESRD), signifies a critical loss of function necessitating renal replacement therapy, like dialysis or transplantation. In the Netherlands, the organization of CKD care aligns with the progression from early stages to ESRD. General practitioners play a key role in the initial stages, focusing on diagnosis, monitoring, and addressing modifiable risk factors, for example by improving health behaviors. Patients often meet with a specialized nurse two to four times per year. As CKD advances, a multidisciplinary care team in nephrology clinics becomes responsible for the diagnosis, monitoring and treatment, and, if needed, for preparing patients for renal replacement therapy. Patients go to consultations regularly to meet with the nephrologist, specialized nurse, dietician or social worker. When patients have ESRD, often dialysis or a kidney transplantation is needed. When patients need dialysis, a machine cleans the blood of waste products of metabolism for multiple hours, multiple days a week. A transplantation requires an operation to gain an additional kidney of either a living or deceased donor. These treatments both come with strict lifestyle regimes and monitoring by the HCPs, as well as multiple medications. SELF-MANAGEMENT AND COMMUNICATION Unhealthy behaviors and low adherence to treatment play an important role in the onset and progression of CKD[37,38]. Therefore, self-management is important to slow the progression of CKD to more severe stages. Selfmanagement refers to the individual’s ability to manage the symptoms, treatment, physical and psychosocial consequences and lifestyle changes inherent in living with a chronic condition[39]. Improved self-management is associated with positive patient outcomes, such as improved health status and reduced hospitalization[40]. Effective self-management of CKD requires that patients integrate new health behaviors into their lives. In CKD-stages 2 and 3, for example, patients need to reduce their salt intake, drink sufficiently, stay or become physically active and stop smoking[20]. Additionally, patients need to take medication timely, monitor medication side-effects, and often need to manage the treatment of multiple diseases at once[41].
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