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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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We searched MEDLINE, EMBASE, PsycINFO, Cochrane Central, and Web of Science (inception\u2013March 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Five RCTs (\n                      <jats:italic>N<\/jats:italic>\n                      \u2009=\u2009631) 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.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Graphical Abstract<\/jats:title>\n                  <\/jats:sec>","DOI":"10.1007\/s40620-025-02372-9","type":"journal-article","created":{"date-parts":[[2025,9,10]],"date-time":"2025-09-10T03:54:20Z","timestamp":1757476460000},"page":"2155-2171","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Do psycho-behavioural interventions improve mental and physical health in chronic kidney disease? 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