The impact of nurse-led care in chronic kidney disease management: a systematic review and meta-analysis.

Abstract

Background: A multidisciplinary approach is widely recommended for the effective management of chronic kidney disease (CKD), with the objective of improving both clinical and psychosocial outcomes. However, resource constraints and increasing demands on healthcare systems have emphasized the necessity for alternative models of care, such as nurse-led interventions. These interventions possess the potential to address critical challenges in CKD management by providing accessible, patient-centered care across diverse healthcare settings.

Objective: This systematic review and meta-analysis aims to compare the effects of nurse-led care with routine care in CKD management to determine its efficacy across diverse cultural backgrounds.

Methods: Following PRISMA guidelines, a comprehensive search was conducted on PubMed, EMBASE, Scopus, and Cochrane databases, supplemented by manual searches and clinical trial registries. Inclusion criteria were randomized controlled trials (RCTs) involving nurse-led care for CKD patients aged 18 or older. Data extraction focused on study and baseline characteristics, and outcomes related to quality of life (symptoms/problems associated with kidney disease, sleep, energy/fatigue, patient satisfaction, overall health, depression, physical functioning, emotional well-being, role-physical, burden of kidney disease), depression, eGFR, and blood pressure. Statistical analysis used RevMan and STATA software, with results reported as standardized mean differences, along with their confidence intervals.

Results: The analysis included 10 RCTs with a total of 964 participants. Nurse-led care significantly improved symptoms/problems associated with kidney disease, sleep quality, pain, energy/fatigue, overall health, and depression. However, no significant improvements were observed in the burden of kidney disease, physical functioning, role-physical, patient satisfaction and emotional well-being. Variability in outcomes related to depression highlights potential heterogeneity among studies. While some trials reported enhanced hospitalization rates and treatment adherence, others showed inconsistent findings, suggesting a need for more rigorous research.

Conclusion: Nurse-led care provides notable benefits in managing certain aspects of CKD, including symptom control, sleep disturbances, energy levels, and overall health. However, its limited impact on kidney function and other clinical outcomes underscores the necessity for developing robust, standardized nurse-led care models and conducting long-term studies to evaluate their comprehensive efficacy.