Health system related kidney supportive care interventions for adults with chronic kidney disease: A systematic review

IF 1.5 4区医学 Q3 NURSING Journal of renal care Pub Date : 2024-12-05 DOI:10.1111/jorc.12517

Dilantha Dharmagunawardene MD, Sanjeewa Kularatna PhD, Ureni Halahakone MHM, Louise Purtell PhD, Ann Bonner PhD, Helen G. Healy PhD, Sameera Senanayake PhD

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Abstract

Introduction

Kidney failure can be managed either conservatively or via kidney replacement therapy. Kidney supportive care combines the expertise of nephrology with palliative care in a multidisciplinary team with a focus on improving quality of life.

Objective

To identify and appraise evidence-based health system kidney supportive care interventions

Design

Systematic review (PROSPERO Registration - CRD42022333650).

Participants

Adults with chronic kidney failure.

Measurements

Six databases were searched, using terms “palliative care” and “chronic kidney disease” for publications between January 2010 and March 2024. The Cochrane “Effective Practice and Organisation of Care” and “Clinical Practice Guidelines for Quality Palliative Care” domains informed data extraction.

Results

Of the 60 studies included, one-third were randomised controlled trials. The most common “Effective Practice and Organisation of Care” domain described was care delivery (58/60). End-of-life care (33/60), and physical aspects of care (19/60), were commonly described “Clinical Practice Guidelines for Quality Palliative Care” domains. Multidisciplinary shared care was highlighted in 26 studies. Least described domains were cultural (0/60) and ethical aspects (3/60). Almost 2/3 (39/60) of studies compared the outcomes of kidney supportive care interventions, and the most common outcome assessed was advance care planning (18/39). Key findings reported integrated palliative care reduced hospital admissions and costs, facilitated better patient-clinician communication, and improved symptom management. Gaps were identified in cultural and ethical/legal aspects of care.

Conclusions

The studies highlighted the effectiveness of kidney-supportive care interventions in improving patient outcomes, especially in end-of-life care and symptom management. However, significant existing gaps identified necessitate further research.

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成人慢性肾病的卫生系统相关肾脏支持护理干预：系统综述。

肾功能衰竭可以通过保守治疗或肾脏替代治疗来治疗。肾脏支持护理结合了肾病学和姑息治疗的专业知识，在一个多学科的团队，重点是提高生活质量。目的：识别和评估基于证据的卫生系统肾脏支持护理干预措施设计：系统评价（PROSPERO注册号：CRD42022333650）。参与者：患有慢性肾衰竭的成年人。测量方法：检索六个数据库，使用术语“姑息治疗”和“慢性肾脏疾病”检索2010年1月至2024年3月之间的出版物。Cochrane“有效实践和护理组织”和“优质姑息治疗临床实践指南”领域为数据提取提供了信息。结果：纳入的60项研究中，三分之一为随机对照试验。最常见的“有效实践和护理组织”描述的领域是护理交付（58/60）。临终关怀（33/60）和身体方面的护理（19/60）通常被描述为“高质量姑息治疗临床实践指南”领域。26项研究强调了多学科共享护理。描述最少的领域是文化方面（0/60）和道德方面（3/60）。几乎2/3（39/60）的研究比较了肾脏支持治疗干预措施的结果，最常见的评估结果是预先护理计划（18/39）。主要发现报告称，综合姑息治疗减少了住院率和费用，促进了更好的医患沟通，并改善了症状管理。在护理的文化和道德/法律方面发现了差距。结论：这些研究强调了肾支持护理干预在改善患者预后方面的有效性，特别是在临终关怀和症状管理方面。然而，已确定的重大现有差距需要进一步研究。

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来源期刊

Journal of renal care Nursing-Advanced and Specialized Nursing

CiteScore

3.50

自引率

5.30%

发文量

期刊介绍： The Journal of Renal Care (JORC), formally EDTNA/ERCA Journal, is the official publication of the European Dialysis and Transplant Nursing Association/European Renal Care Association (EDTNA/ERCA). The Journal of Renal Care is an international peer-reviewed journal for the multi-professional health care team caring for people with kidney disease and those who research this specialised area of health care. Kidney disease is a chronic illness with four basic treatments: haemodialysis, peritoneal dialysis conservative management and transplantation, which includes emptive transplantation, living donor & cadavaric transplantation. The continuous world-wide increase of people with chronic kidney disease (CKD) means that research and shared knowledge into the causes and treatment is vital to delay the progression of CKD and to improve treatments and the care given. The Journal of Renal Care is an important journal for all health-care professionals working in this and associated conditions, such as diabetes and cardio-vascular disease amongst others. It covers the trajectory of the disease from the first diagnosis to palliative care and includes acute renal injury. The Journal of Renal Care accepts that kidney disease affects not only the patients but also their families and significant others and provides a forum for both the psycho-social and physiological aspects of the disease.