Will a meditation-based psychotherapeutic intervention (online-based), compared to a series of illness-related education sessions with similar group support, therapeutic alliance and instructor attention, increase perceived health related quality of life and reduce psychological distress in Sinhala-conversant, non-renal replacement-therapy patients diagnosed with stage IV and V chronic kidney disease (CKD)?

Study setting: Faculty of Medicine, University of Colombo, Sri Lanka and the National Hospital of Sri Lanka (NHSL), Colombo

Randomization: Selected participants (i.e. stage IV and V CKD patients who are at a non-renal replacement therapy stage and attending renal care clinics at the National Hospital of Sri Lanka, Colombo) will be divided into two groups; intervention/treatment group and the active control/non-treatment group, randomly (i.e., using block randomization with 1:1 allocation ratio, 5 blocks) using an online automatic random number generator (link to random number generator: http://www.randomizer.org/).

Intervention: The proposed meditation-based psychotherapeutic intervention (MBPI) will consist of eight weekly (1 per week) sessions through which three meditation techniques (i.e., walking meditation, body scan meditation, and loving-kindness meditation) will be gradually introduced to the participants by trained meditators. Intervention group participants (n=56) will be instructed to maintain a home-based meditation practice of 40 minutes in between sessions and their practice will be aided by weekly recordings. The participants will be asked to record their practice time and experience in a booklet/journal, and this will be used as a means of monitoring their home based practice. Furthermore, the data from the journals will be analyzed post-intervention to further analyze the meditation experience of the participants. Each session will further include a brief introductory psychoeducation component at the beginning (approximately 10 min). At the end of the session, the participants will engage in a discussion (approximately 20 min) with the researchers and the meditation trainers where they will be able to discuss their questions, concerns and experiences. Each session will be conducted for a period of 1 – 1.5 hours. The intervention will be delivered in a hybrid mode where sessions 1 and 8 will be conducted onsite and sessions 2-7 will be conducted online. Participants will be asked to have their mobile phone / computer cameras switched on (they will be informed of this during the recruitment and informed consent process), thus enabling the researchers and the trainer to observe and guide them.

Active control condition: The participants chosen for the active control condition (n=56) will be delivered with illness-related education sessions parallel to the intervention group. This active control condition will follow the design of an active control group with a non-specific treatment component. This design is also named as an attention placebo group. As placebo effects are often attributed to clinical interactions and contextual factors that affect the expectations of the patient about the treatment and result in symptom change, complying by this design, we hope to provide the control group with similar time and attention from a professional figure compared to the intervention group. This will be done by providing illness-related education to the control group through 8 weeks similar to the intervention group. They too will engage in a discussion with professional facilitators who will be medical doctors, where their questions, concerns, and experiences will be discussed. These sessions will also run parallel to the sessions with the intervention group and this group will also participate in eight sessions conducted in a hybrid manner; 1st and 8th session onsite and sessions 2-7 online. This group will be waitlisted to receive the MBPI after its completion with the intervention group.

Standard treatment/care: as usual (non-specific) for CKD populations include regular dialysis (only for Renal Replacement Therapy patients), supplements of vitamins and micronutrients, nutritional advice, and drugs to improve the hemoglobin levels.

Note: at the end of the intervention period the intervention group too will be given leaflets with this helpful illness related education content printed on them.

1. Chronic Kidney Disease (CKD) patients who are in stage IV and V of illness, as identified by a Consultant Nephrologist/senior registrar of nephrology/consultant physician or through the estimated Glomeular Filtration Rate (eGFR) blood test where eGFR levels are less than 30 ml/min.
2. Stage IV and V CKD patients who are not currently going through dialysis procedures /(i.e., non-renal replacement therapy (non-RRT) patients)
3. Stage IV or V CKD patients who show mild – severe pretreatment scores for depression (10-27) and / or anxiety (08-19) as measured through the Sinhala version of the Depression, Anxiety, Stress Scale (DASS-21) during participant screening (Participants who show extreme severity in these domains will be referred for psychiatric assessment).
4. 18-70 years old, males and females
5. Participants who are conversant in Sinhala and show the ability to understand the Sinhala language in order to complete study measures, to understand the content and material delivered through the programme and to engage in discussions conducted in Sinhala.
6. Participants who have a smart phone/desktop computer or laptop at home and an internet connection that is available to be used for zoom sessions held once a week (data cards will be provided and technical guidance will be provided if/when needed).

1. CKD patients expecting to receive RRTs (i.e., dialysis and renal transplant) within the next six months from the time of recruitment.
2. CKD patients who present with rapid progressive renal disease
3. CKD patients who have comorbidities such as severe anemia conditions, severe edema and severe arthritis.
4. Obtaining psychological treatment and/or psychotropic medication at the moment or have obtained within the past five years.
5. Presenting with suicidal ideation as identified by a psychologist (i.e., the primary researcher) during participant selection/screening.
6. Following alternative treatment modalities including Ayurveda medicine, indigenous medicine, and homeopathy medicine.
7. Engaging in regular meditation practices (including yoga and relaxation techniques) for more than once/twice a month for the past five years.
8. Experiencing difficulties in reading and/or writing and having only completed mid-secondary education (i.e., grade 11 or lower in local and/or international education syllabus)