Systematic Review and Network Meta-Analysis of the Comparative Effectiveness of Adherence Enhancement Strategies in Chronic Kidney Disease

IF 3.5 2区医学 Q1 MEDICINE, GENERAL & INTERNAL

Journal of Evidence‐Based Medicine Pub Date : 2025-09-24 DOI:10.1111/jebm.70078

Bin Ma, Yuanmin Jia, Haixia Wang, Ou Chen

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引用次数: 0

Abstract

Objective

To evaluate and compare the effectiveness of adherence-enhancement strategies in patients with chronic kidney disease (CKD).

Methods

Nine databases (PubMed, Embase, The Cochrane Library, Web of Science, Scopus, CNKI, VIP, WanFang, and CBM) were searched for randomized controlled trials (RCTs) to April 1, 2025. Two reviewers independently screened, extracted data, and assessed risk of bias with the Cochrane Risk of Bias 2.0 tool. Certainty of evidence was appraised using the Confidence in Network Meta-Analysis (CINeMA) tool. Network meta-analysis was performed, and surface under the cumulative ranking curve (SUCRA) was calculated to rank interventions. The review was registered in PROSPERO (CRD42024604771).

Results

Thirty-five RCTs with 5084 patients were included. Evidence quality was limited by high risk of bias and low certainty. For medication adherence, education plus phone follow-up with short message service education showed the greatest effect (standardized mean differences [SMD] = 2.15, 95% confidence interval [CI] 1.09–3.21; SUCRA = 98.7), followed by empowerment (SMD = 1.19, 95% CI 0.20–2.18; SUCRA = 82.1). For diet adherence, education with phone follow-up was most effective (SMD = 6.68, 95% CI 5.64–7.71; SUCRA = 100), with empowerment also beneficial (SMD = 1.83, 95% CI 1.23–2.43; SUCRA = 87.9). For fluid adherence, education with medication management and pharmacist follow-up was most effective on scale-based outcomes (SMD = 3.06, 95% CI 2.18–3.94; SUCRA = 99.8), while cognitive behavioral therapy reduced interdialytic weight gain (SMD = −0.76, 95% CI −1.30 to −0.22; SUCRA = 71.1).

Conclusions

Adherence-enhancement strategies improve medication, diet, and fluid adherence in CKD. High-quality RCTs are needed to confirm these findings.

Abstract Image

查看原文本刊更多论文

慢性肾脏疾病依从性增强策略比较效果的系统评价和网络meta分析。

目的：评价和比较慢性肾脏疾病（CKD）患者的依从性增强策略的有效性。方法：检索截至2025年4月1日的9个数据库（PubMed、Embase、The Cochrane Library、Web of Science、Scopus、CNKI、VIP、万方、CBM），检索随机对照试验（RCTs）。两位审稿人独立筛选、提取数据，并使用Cochrane risk of bias 2.0工具评估偏倚风险。使用网络元分析（CINeMA）工具评估证据的确定性。采用网络元分析，计算累积排序曲线下曲面（SUCRA）对干预措施进行排序。该综述已在PROSPERO注册（CRD42024604771）。结果：纳入35项随机对照试验，共5084例患者。证据质量受到高偏倚风险和低确定性的限制。在服药依从性方面，教育加电话随访加短信服务教育效果最大（标准化平均差值[SMD] = 2.15, 95%可信区间[CI] 1.99 ~ 3.21; SUCRA = 98.7），其次是赋权（SMD = 1.19, 95% CI 0.20 ~ 2.18; SUCRA = 82.1）。对于饮食依从性，电话随访的教育最有效（SMD = 6.68, 95% CI 5.64-7.71; SUCRA = 100），授权也有益（SMD = 1.83, 95% CI 1.23-2.43; SUCRA = 87.9）。对于液体依从性，药物管理教育和药剂师随访对基于量表的结果最有效（SMD = 3.06, 95% CI 2.18-3.94; SUCRA = 99.8），而认知行为治疗减少了透析间期体重增加（SMD = -0.76, 95% CI -1.30至-0.22;SUCRA = 71.1）。结论：依从性增强策略改善了CKD患者的药物、饮食和液体依从性。需要高质量的随机对照试验来证实这些发现。

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来源期刊

Journal of Evidence‐Based Medicine MEDICINE, GENERAL & INTERNAL-

CiteScore

11.20

自引率

1.40%

发文量

期刊介绍： The Journal of Evidence-Based Medicine (EMB) is an esteemed international healthcare and medical decision-making journal, dedicated to publishing groundbreaking research outcomes in evidence-based decision-making, research, practice, and education. Serving as the official English-language journal of the Cochrane China Centre and West China Hospital of Sichuan University, we eagerly welcome editorials, commentaries, and systematic reviews encompassing various topics such as clinical trials, policy, drug and patient safety, education, and knowledge translation.