Health system related kidney supportive care interventions for adults with chronic kidney disease: A systematic review

Dilantha Dharmagunawardene; Sanjeewa Kularatna; Ureni Halahakone; Louise Purtell; Ann Bonner; Helen G Healy; Sameera Senanayake

doi:10.1111/jorc.12517

Health system related kidney supportive care interventions for adults with chronic kidney disease: A systematic review

J Ren Care. 2025 Mar;51(1):e12517. doi: 10.1111/jorc.12517.

Authors

Dilantha Dharmagunawardene^{1

2}, Sanjeewa Kularatna^{3

4}, Ureni Halahakone³, Louise Purtell⁵, Ann Bonner⁵, Helen G Healy⁶, Sameera Senanayake^{3

4}

Affiliations

¹ School of Applied Psychology, Griffith Health, Griffith University, South Bank Campus, Brisbane, Australia.
² Ministry of Health, Colombo, Sri Lanka.
³ Australian Centre for Health Services Innovation (AusHSI) and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia.
⁴ Health Services and Systems Research, Duke-NUS Medical School, National University of Singapore, Singapore, Singapore.
⁵ School of Nursing and Midwifery, Griffith University, Gold Coast Campus, Gold Coast, Australia.
⁶ Royal Brisbane and Women's Hospital, Herstone, Australia.

PMID: 39639604
DOI: 10.1111/jorc.12517

Abstract

Introduction: Kidney failure can be managed either conservatively or via kidney replacement therapy. Kidney supportive care combines the expertise of nephrology with palliative care in a multidisciplinary team with a focus on improving quality of life.

Objective: To identify and appraise evidence-based health system kidney supportive care interventions DESIGN: Systematic review (PROSPERO Registration - CRD42022333650).

Participants: Adults with chronic kidney failure.

Measurements: Six databases were searched, using terms "palliative care" and "chronic kidney disease" for publications between January 2010 and March 2024. The Cochrane "Effective Practice and Organisation of Care" and "Clinical Practice Guidelines for Quality Palliative Care" domains informed data extraction.

Results: Of the 60 studies included, one-third were randomised controlled trials. The most common "Effective Practice and Organisation of Care" domain described was care delivery (58/60). End-of-life care (33/60), and physical aspects of care (19/60), were commonly described "Clinical Practice Guidelines for Quality Palliative Care" domains. Multidisciplinary shared care was highlighted in 26 studies. Least described domains were cultural (0/60) and ethical aspects (3/60). Almost 2/3 (39/60) of studies compared the outcomes of kidney supportive care interventions, and the most common outcome assessed was advance care planning (18/39). Key findings reported integrated palliative care reduced hospital admissions and costs, facilitated better patient-clinician communication, and improved symptom management. Gaps were identified in cultural and ethical/legal aspects of care.

Conclusions: The studies highlighted the effectiveness of kidney-supportive care interventions in improving patient outcomes, especially in end-of-life care and symptom management. However, significant existing gaps identified necessitate further research.

Keywords: chronic kidney disease; palliative care; psychosocial; research.

Publication types

Systematic Review
Review

MeSH terms

Adult
Humans
Palliative Care* / methods
Palliative Care* / standards
Quality of Life / psychology
Renal Insufficiency, Chronic* / psychology
Renal Insufficiency, Chronic* / therapy

Grants and funding

None