Reconstructing Life with Chronic Kidney Disease in Contexts of Health Inequality: A Grounded Theory Developed in...

Chronic kidney disease (CKD) is a major public health challenge associated with substantial physical, psychological, social, and economic consequences. Although its clinical outcomes have been extensively investigated, less is known about how individuals progressively reconstruct their lives while living with an irreversible condition requiring long-term dialysis, particularly in contexts characterized by health inequities. This study aimed to develop a substantive theory explaining how adults reconstruct their lives while living with CKD on dialysis. A qualitative study was conducted using Strauss and Corbin's Grounded Theory methodology. Eighteen adults receiving hemodialysis or peritoneal dialysis in Chile participated in semi-structured interviews. Data collection and analysis were conducted concurrently using theoretical sampling, the constant comparative method, memo writing, and theoretical saturation. The findings identified "Reconstructing Life While Living with Chronic Kidney Disease" as the central phenomenon. Life reconstruction emerged as a dynamic and ongoing process sustained by the interaction between resignation and survival and facilitated by three interrelated conditions: understanding the disease, social support networks, and nursing care. Through this process, participants progressively reorganized their identities, everyday lives, interpersonal relationships, and future life projects while living with an irreversible chronic condition. The resulting substantive theory provides a contextually grounded explanation of life reconstruction that integrates individual, relational, and social dimensions of living with CKD. By demonstrating that opportunities for life reconstruction are shaped not only by individual agency but also by supportive social and healthcare conditions, the findings contribute to nursing knowledge and provide a conceptual foundation for person-centered care, health equity, and future research on chronic illness.