A nurse‐coordinated model of care versus usual care for chronic kidney disease: meta‐analysis

Haidan Xu, Lisha Mou and Zhiming Cai

Journal of Clinical Nursing, 2017, vol. 26, issue 11-12, 1639-1649

Abstract: Aim To investigate whether a nurse‐led care was more beneficial for implementing chronic kidney disease guidelines and improved multiple risk factors compared with the usual care. Background Several independent clinical trials have been carried out to demonstrate the efficiency of a nurse‐led care to improve the outcomes for patients with chronic kidney disease and address the risk factors for renal function decline. However, their results and conclusions were inconsistent. Methods A meta‐analysis was carried out on September 2015 based on previous studies that evaluated the efficiency of nurse‐led care model for patients with chronic kidney disease. Following quality appraisal, four randomised clinical trials that allocated patients with chronic kidney disease to usual care and nurse‐coordinated care were included. Primary outcomes, such as kidney failure and cardiovascular events, were analysed. Results Compared with the usual care group, a nurse‐coordinated care model reduced the risks of composite death, decreased the occurrence rate of end‐stage renal disease and doubled serum creatinine. On the contrary, a slight propulsive effect of nurse‐led interventional care occurred on acute myocardial infarction and heart failure. Limitations Only five studies were included and conducted nonstandard evaluating endpoints, causing fewer studies were categorised in each outcome events in this meta‐analysis, subsequently leading to heterogeneity and less persuasive. Conclusions Intensive interventions delivered by nurse coordinators are expected to benefit patients to attain longer life expectancy and higher life quality as well as to improve controlling risk factors implicated in chronic kidney disease progression. Relevance to clinical practice More government and hospitals should modify the traditional nursing routine based on this study, providing a more intensive nurse‐coaching care model for patients with chronic kidney disease, even aged or other chronic diseases, which shall further help to better control the risk factors and delay disease progression.

Date: 2017
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