Effectiveness of comprehensive medical care support by healthcare professionals, including nurses, in patients undergoing hemodialysis: a systematic review and meta-analysis

Abstract Background Patients undergoing hemodialysis are at increased risk of physical, psychological, and lifestyle-related complications that negatively impact clinical outcomes. Although comprehensive medical care support (CMCS), particularly from nurse-inclusive multidisciplinary teams, may help address these challenges, its effectiveness remains uncertain. This study evaluated the effectiveness of CMCS provided by nurse-inclusive healthcare professionals in improving outcomes among adult patients undergoing hemodialysis. Methods We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) assessing comprehensive care interventions delivered by nurse-inclusive healthcare professionals. Eligible studies included adult patients undergoing hemodialysis and reported outcomes related to physical function, dialysis-related complications, health-related quality of life (HR-QOL), or self-management ability. Literature searches were conducted in MEDLINE (via PubMed) and Ichushi-Web (January 1970–April 2024). The risk of bias was assessed using the Cochrane Risk of Bias Tool (RoB 2) tool, and the certainty of evidence (COE) was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach. Results The qualitative synthesis and meta-analysis comprised 25 and 11 RCTs, respectively. A total of 2093 participants were enrolled across the 25 studies. Comprehensive care interventions significantly improved normal gait speed (mean difference [MD] = 10.51 cm/s; 95% confidence interval [CI]: 3.58 to 17.44), systolic blood pressure (MD = −8.07 mmHg; 95% CI −15.57 to −0.58), diastolic blood pressure (MD = −5.79 mmHg; 95% CI −7.89 to −3.69), and the physical component summary of HR-QOL (standardized mean difference = 0.22; 95% CI: 0.003 to 0.44). No significant improvements were observed in the mental component summary of HR-QOL or in self-management outcomes, with high heterogeneity across studies. COE ranged from very low to moderate. Conclusions CMCS provided by nurse-inclusive healthcare professionals may enhance physical function, blood pressure control, and physical aspects of HR-QOL in patients undergoing hemodialysis. However, further high-quality studies are needed to determine the long-term benefits and to optimize interdisciplinary approaches targeting self-management and psychological outcomes. PROSPERO Registration : CRD42024537551.