通过数字健康干预提高透析患者的治疗依从性：随机对照试验的系统评价和荟萃分析

Enhancing treatment adherence in dialysis patients through digital health interventions: a systematic review and meta-analysis of randomized controlled trials.

作者信息

Zhang Zhe, Liang Xin-Ting, He Xu-Wei, Zhang Xian, Tang Rui, Fang Rui-Duo, Li Jin-Zhu

机构信息

Department of the Six Health Care, The Second Medical Center and National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China.

Chinese PLA Medical School, Beijing, China.

出版信息

Ren Fail. 2025 Dec;47(1):2482885. doi: 10.1080/0886022X.2025.2482885. Epub 2025 Mar 26.

DOI:10.1080/0886022X.2025.2482885

PMID:40140982

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11951323/

Abstract

OBJECTIVE

To systematically assess the efficacy of digital health interventions (DHIs) for improving treatment adherence among dialysis patients through a meta-analysis of randomized controlled trials (RCTs).

METHODS

Five databases were systematically searched from inception to April 2024. Meta-analyses were performed to calculate standardized mean differences (SMDs) and 95% confidence intervals (CIs) for adherence outcomes. Evidence quality was evaluated using the GRADE approach.

RESULTS

Seventeen RCTs involving 1,438 dialysis patients were analyzed. DHIs significantly improved overall adherence (SMD 1.88 [95% CI: 0.46-3.29]; 4 trials, low-certainty evidence). Specifically, DHIs demonstrated large improvements in medication adherence (SMD 1.45 [95% CI 0.38-2.52]; 4 trials, 300 patients; low-certainty evidence) and dialysis treatment adherence (SMD 1.88 [95% CI 0.46-3.29]; 4 trials, 245 patients; low-certainty evidence). Moderate improvements were observed in dietary adherence (SMD 0.58 [95% CI 0.25-0.91]; 4 trials, 344 patients; moderate-certainty evidence) and fluid management adherence (SMD -0.36 [95% CI -0.64 to -0.07]; 7 trials, 619 patients; moderate-certainty evidence).

CONCLUSIONS

Digital health interventions effectively enhance multiple dimensions of treatment adherence in dialysis patients, underscoring their value for incorporation into routine clinical practice.

摘要

目的

通过对随机对照试验（RCT）的荟萃分析，系统评估数字健康干预措施（DHI）对提高透析患者治疗依从性的疗效。

方法

对五个数据库从创建至2024年4月进行系统检索。进行荟萃分析以计算依从性结果的标准化平均差（SMD）和95%置信区间（CI）。采用GRADE方法评估证据质量。

结果

分析了17项涉及1438例透析患者的RCT。DHI显著提高了总体依从性（SMD 1.88 [95%CI：0.46 - 3.29]；4项试验，低确定性证据）。具体而言，DHI在药物依从性方面有大幅改善（SMD 1.45 [95%CI 0.38 - 2.52]；4项试验，300例患者；低确定性证据）以及透析治疗依从性（SMD 1.88 [95%CI 0.46 - 3.29]；4项试验，245例患者；低确定性证据）。在饮食依从性方面观察到中度改善（SMD 0.58 [95%CI 0.25 - 0.91]；4项试验，344例患者；中度确定性证据）和液体管理依从性（SMD -0.36 [95%CI -0.64至 -0.07]；7项试验，619例患者；中度确定性证据）。