Original Investigation
Pathogenesis and Treatment of Kidney Disease
Educational Interventions in Kidney Disease Care: A Systematic Review of Randomized Trials

https://doi.org/10.1053/j.ajkd.2008.01.024Get rights and content

Background

There is increasing evidence that educational interventions aimed at empowering patients are successful in chronic disease management. Our aim was to conduct a systematic review of the effectiveness of such educational interventions in people with kidney disease.

Systematic Review

A comprehensive search strategy was applied by using major electronic databases from 1980 to March 2007. Researchers independently reviewed titles and abstracts and extracted data from identified studies.

Setting & Population

Patients in any of the following stages of chronic kidney disease: early, predialysis, and dialysis. Kidney transplant recipients were excluded because this group has additional educational needs that are beyond the scope of this review.

Selection Criteria for Studies

Randomized controlled trials.

Interventions

Structured educational interventions (involving informational and psychological components) with usual care.

Outcomes

Clinical, behavioral, psychological, and knowledge outcomes were considered.

Results

22 studies were identified involving a wide range of multicomponent interventions with variable aims and outcomes depending on the area of kidney disease care. 18 studies provided significant results for at least 1 of the outcomes. The majority of studies aimed to improve diet and/or fluid concordance in dialysis patients and involved short- and medium-term follow-up. A single major long-term study was a 20-year follow-up of a predialysis educational intervention that showed increased survival rates. No study was found that addressed chronic kidney disease at an earlier stage.

Limitations

Meta-analysis was not possible because of study heterogeneity.

Conclusions

Multicomponent structured educational interventions were effective in predialysis and dialysis care, but the quality of many studies was suboptimal. Effective frameworks to develop, implement, and evaluate educational interventions are required, especially those that target patients with early stages of chronic kidney disease. This could lead to possible prevention or delay in progression of kidney disease.

Section snippets

Selection Criteria

We included randomized controlled trials (RCTs) of educational interventions that fulfilled the following inclusion criteria: (1) patients with kidney disease who were in the categories of early CKD, predialysis, or dialysis care (kidney transplant recipients were excluded because this group has additional educational needs that are beyond the scope of the review); (2) structured interventions that involved both informational and psychological components; (3) adults older than 18 years; (4) a

Description of Studies

Twenty-two studies met all predefined criteria. These studies were conducted between 1981 and 2005 in the following countries: United States (11 studies), Canada (5 studies), United Kingdom (2 studies), The Netherlands (1 study), and Taiwan (3 studies). The 22 studies included 1,967 patients, with sample sizes ranging from 10 to 335 participants. All studies included men and women in varying proportions with a mean age of 55 years (range, 19 to 82 years).

Key characteristics of RCTs are listed

Discussion

Limited evidence is available evaluating the effect of patient education in kidney disease care. We identified 22 RCTs evaluating a wide variety of educational interventions with many different aims and outcomes. The majority of studies involved dialysis patients (short and medium duration) and aimed to improve diet and/or fluid concordance. The major study was a 20-year follow-up of a predialysis intervention that showed an increase in survival rates.9 We did not identify studies that

Acknowledgements

The authors thank Bahereh Arsalanizadeh for help reviewing articles for inclusion in the study.

Support: The research was supported by funding from Kidney Research UK (The Edith Murphy Fellowship Programme).

Financial Disclosure: None.

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    Originally published online as doi:10.1053/j.ajkd.2008.01.024 on April 25, 2008.

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