Abstract
BACKGROUND: Depression and anxiety are common in chronic kidney disease (CKD) and worsen clinical outcomes. Psycho-behavioural interventions offer a promising, non-pharmacological approach. However, most evidence comes from people with kidney failure with distinct treatment needs, limiting relevance to earlier stages of CKD, where timely support may enhance self-management and slow progression. This systematic review evaluates the effectiveness of psycho-behavioural interventions in adults with CKD without dialysis or transplantation. METHODS: We searched MEDLINE, EMBASE, PsycINFO, Cochrane Central, and Web of Science (inception-March 2025) for randomised controlled trials (RCTs) testing psycho-behavioural interventions in adults with CKD (not on kidney replacement therapy), with depression and/or anxiety as primary or secondary outcomes. Risk of bias (RoB-2) and certainty of evidence were assessed. Given methodological heterogeneity across studies, vote counting by effect size and narrative synthesis were applied. PROSPERO: CRD42024515733. RESULTS: Five RCTs (N = 631) met the inclusion criteria, evaluating cognitive behavioural therapy, self-efficacy training, mindfulness-based stress reduction, and physical activity, delivered digitally, by phone, or in person. Moderate-certainty evidence showed consistent improvements (100% positive) in self-efficacy and physical function. Low-certainty evidence indicated 100% positive effects on self-management, while findings for depression were mixed (67% positive), with one study reporting worsening symptoms. Evidence for anxiety, fatigue, quality of life, and kidney function was inconclusive due to high inconsistency and imprecision. CONCLUSION: Psycho-behavioural interventions may enhance self-efficacy, self-management, and physical function in CKD. However, evidence for mental health and kidney outcomes remains limited. Robust, long-term RCTs with tailored, multi-component approaches are needed to support integration into kidney care.