Sultan Bushra, Froelicher Erika S
Shifa College of Nursing, Shifa Tameer- e- Millat University, Sector H-8/4 Islamabad, Pakistan -
Shifa College of Nursing, Shifa Tameer- e- Millat University, Sector H-8/4 Islamabad, Pakistan.
Minerva Urol Nephrol. 2025 Mar 7. doi: 10.23736/S2724-6051.24.05718-5.
Hemodialysis constitutes a protracted therapeutic intervention for renal failure, characterized by symptoms that exert a considerable toll on quality of life owing to their intensity and frequent recurrence. Patient education and engagement has been shown to enhance adherence, thereby improving treatment effectiveness and quality of life. The objective of this systematic review was to assess the effectiveness of patient education on improving adherence to treatment and enhancing quality of life among individuals undergoing hemodialysis.
The systematic review and meta-analysis followed PRISMA's Preferred Reporting Item for Systematic Review and Meta-Analysis guidelines. The studies were evaluated utilizing the Joanna Briggs Institute methodology. The search utilized several databases including PubMed, CINAHL, Ovid, Wiley Online Library, Springer Link, and Google Scholar. Studies that specifically examined treatment adherence encompassing aspect such as fluid restriction, dietary modification, medication usage, electrolyte balance, and interdialytic weight management) as well as those assessing quality of life were included in this review.
A total of 15 studies met the inclusion criteria. The studies explored adherence to various facets of treatment including fluids and electrolytes management (potassium, phosphate, creatinine level), medication usage (compliance with prescribe medication), dietary practices (adaptation according to disease and hemodialysis requirement), interdialytic weight management, and quality of life. Seven of these studies focus on investigating the quality of life, while the remaining eight examined specific components of treatment adherence. Due to the variation in methods, the results are described narratively. A quantitative synthesis was conducted using Revman 5.0 to assess the impact of educational intervention. This meta-analysis evaluated the pooled effects of adherence to fluids, electrolytes (creatinine), diet, and quality of life. A significant improvement is shown in fluid adherence (MD=35.18, 95% CI: 22.35, 48.0) (overall effect Z=5.38, P<0.0001), dietary modification (MD=37.50, 95% CI: 24.65, 50.35) (Overall effect Z=5.72, P=0.0001), and quality of life (MD=8.50, 95% CI: 4.50, 12.50, (overall effect Z=4.17, P=0.0001). However, no significant effect is observed on the creatinine level (MD=-0.50, 95% CI: -1.38, 0.38) (Z=1.12, P=0.026). The observed level of heterogeneity ranged from low to moderate.
Hemodialysis impacts various aspects of patients' lives. This systematic review shows that nursing education and behavior monitoring in patients undergoing hemodialysis contributes to improving their adherence to treatment and quality of life. The evaluated pooled effect and mean difference in meta-analysis findings shows that the educational interventions improve adherence to fluids and diet, as well as maintain creatinine balance and enhance quality of life.
血液透析是针对肾衰竭的一种长期治疗手段，其症状因其强度和频繁复发而对生活质量造成相当大的影响。研究表明，患者教育和参与可提高依从性，从而改善治疗效果和生活质量。本系统评价的目的是评估患者教育对提高血液透析患者治疗依从性和改善生活质量的有效性。
本系统评价和荟萃分析遵循PRISMA（系统评价和荟萃分析的首选报告项目）指南。采用乔安娜·布里格斯研究所的方法对研究进行评估。检索使用了多个数据库，包括PubMed、CINAHL、Ovid、Wiley Online Library、Springer Link和谷歌学术。本评价纳入了专门研究治疗依从性（包括液体限制、饮食调整、药物使用、电解质平衡和透析间期体重管理等方面）以及评估生活质量的研究。
共有15项研究符合纳入标准。这些研究探讨了对治疗各个方面的依从性，包括液体和电解质管理（钾、磷、肌酐水平）、药物使用（遵医嘱用药）、饮食习惯（根据疾病和血液透析需求进行调整）、透析间期体重管理以及生活质量。其中7项研究专注于调查生活质量，其余8项研究则考察了治疗依从性的具体组成部分。由于方法存在差异，结果采用叙述性描述。使用Revman 5.0进行定量综合分析，以评估教育干预的影响。该荟萃分析评估了对液体、电解质（肌酐）、饮食的依从性以及生活质量的合并效应。结果显示，在液体依从性方面有显著改善（MD = 35.18，95%CI：22.35，48.0）（总体效应Z = 5.38，P < 0.0001），饮食调整方面（MD = 37.50，95%CI：24.65，50.35）（总体效应Z = 5.72，P = 0.0001），以及生活质量方面（MD = 8.50，95%CI：4.50，12.50，总体效应Z = 4.17，P = 0.000）。然而，在肌酐水平方面未观察到显著影响（MD = -0.50，95%CI：-1.38，0.38）（Z = 1.12，P = 0.26）。观察到的异质性水平为低到中度。
血液透析会影响患者生活的各个方面。本系统评价表明，对血液透析患者进行护理教育和行为监测有助于提高他们的治疗依从性和生活质量。荟萃分析结果中评估的合并效应和平均差异表明，教育干预可提高对液体和饮食的依从性，维持肌酐平衡并改善生活质量。
