Table 3.

Reported treatment advice and related self-management situations across comorbid chronic conditions

CKD Treatment Advice	Comorbidity	Comorbidity Treatment Advice	Self-Management Situation	Examples of Self-Management Conflict
Avoid NSAIDs	Arthritis, gout	Take NSAIDs	Discordant	“[L]ast week I had tremendous gout attack in my wrists, I mean it was swoll and I couldn’t, if I try to move my wrist that far, I was in excruciating pain, so I took some Aleve, which I’m not supposed to take, but it relieved the pain that I had, it was the only thing that I had that would relieve the pain” (FG1)
				“Got a little arthritis and things like that, that I need anti-inflammatories” (FG1)
Drink plenty of water	Heart failure	Avoid drinking water	Discordant	“One doctor says drink a lot of water. Another doctor says you’re drinking too much water. Well, what is it?” (FG3)
				“One of the doctors mentioned the volume of water that I should drink, and then another said ‘Don’t drink very much water; you got too much as it is.’ So I’m caught in between so I just take it when I get thirsty, I get something to drink.” (FG6)
				“They told me to drink water, a lot of water. But, then my cardiologist told me not to drink too much water.” (FG2)
Avoid potassium	Hypokalemia – leg cramps	Take potassium pills Eat high-potassium foods	Discordant	“…but I’ve got to have so many bananas. That’s the way I can keep from getting leg cramps at night” (FG1)
				“[I]f potassium is a problem for the kidney, why would your doctor give you potassium pills, why? So, evidently that is not affecting my kidneys….Because I take 10 mg of potassium and that is from my doctor.” (FG2)
Avoid protein	Gout	Avoid protein	Concordant	“I mostly just reduce the amount of meat. I have gout too like the gentleman number 5 here. Does anyone else have gout here? I just wondered how common it is with kidney problems. Anyhow, I just have to watch these kinds of foods with the gout too.” (FG1)
				“I have gout also. So I have two things working there. I can’t have steak anymore, because it is red meat and it [also] activates the gout.” (FG3)
Take medicine for hypertension	Hypertension	Take medicine for hypertension	Concordant	“That’s what every doctor, my primary care and all, says. The most dangerous thing is BP for kidneys, that’s the most dangerous. If you keep your BP under control that is better for your kidneys.” (FG2)
				“High BP. If you have to put it to one thing, high BP, that’s what they tell me.... That’s the worst thing in the world, gives you everything. That’s the worst thing in the world.” (FG3)
Limit potassium (fruit juices), phosphorus (colas)	Diabetes	Avoid sugar (sugar sweetened beverages)	Concordant	Facilitator: “…has the dietician or doctor told you to cut back on things like bananas?….”
				“Yeah. Bananas and pineapples. They got so much sugar.” (FG5)
				“Well in relation to that and your diabetes. They tell you not to drink the colored drinks and try to stay more with clear drinks, and that’s good for your kidneys. Drink mostly water, you know.” (FG6)
Adhere to treatment recommendations	Mental health issues (i.e., addiction, PTSD)	Adhere to treatment recommendations	Unrelated	“I’m an addict. I have to acknowledge that, every time I eat, every time I drink. So I have to try and not eat and those things that feed into my addiction…. Stay away from certain things….Salt.” (FG5)
				“Many veterans today, people who have problems, tend to say if they’re asked, they say ‘I’m ok.’ Well, that’s a lie, you’re not ok, you do have a problem. Like so many guys walking around with the PTSD. They say, ‘I’m ok.’ Well you’re not ok, because you do have a problem.” (FG6)

We present treatment advice here in lay terms used by focus group participants rather than back-translating participant language into clinical terminology. NSAIDs, nonsteroidal anti-inflammatory drugs; FG, focus group; PTSD, post-traumatic stress disorder.