Achieving consensus on psychosocial and physical rehabilitation management for people living with kidney disease

Following two rounds of surveys and a consensus workshop, all 16 statements achieved high consensus (>90% affirmative votes). Key priority recommendations include conducting holistic wellbeing assessments for patients approaching dialysis or transplantation, using validated tools like the PHQ-4 and Distress Thermometer, integrating assessment scores into the NHS Renal Data Dashboard, and ensuring access to appropriate referral pathways. The process identified a single initially contentious point regarding assessment at CKD stage 4+, which was resolved by emphasizing preventative approaches while prioritizing resources for those nearer end-stage disease. The final recommendations are intended to be included in the NHS England Renal Services Transformation Programme commissioning toolkit. Limitations include the inherent nature of a Delphi process, which synthesizes expert opinion rather than generating direct clinical evidence from patient outcomes.