JMIR Publications

ABSTRACT

Background:

End-stage kidney disease (ESKD) imposes a significant global health burden, with patients often experiencing poor quality of life due to psychological distress and low self-efficacy. Digital health interventions (DHIs) have emerged as a promising solution to improve the psychological health, self-efficacy, and quality of life of patients with ESKD. However, the effects of DHI in this population remain inconsistent, and a comprehensive review of the evidence is lacking.

Objective:

To assess the impact of DHIs on the psychological health, self-efficacy, and quality of life of ESKD patients.

Methods:

A comprehensive search was conducted across six electronic databases (PubMed, Web of Science, Cochrane Library, PsycINFO, Embase, and CINAHL) up to January 21, 2025. Randomized controlled trials (RCTs) examining the effects of DHI on ESKD patients' psychological health, self-efficacy, or quality of life were included. Two authors independently screened studies, extracted data, and assessed the risk of bias using the RoB 2 tool. Meta-analysis was performed using Review Manager 5.4, with subgroup analyses based on treatment modality, intervention type, and duration. Evidence quality was assessed using the GRADE approach.

Results:

This systematic review included 23 RCTs involving 2,407 ESKD patients from 12 countries. The meta-analysis showed that DHI significantly improved depression (SMD: -0.41, 95% CI: [-0.63, -0.19], P=.003) and overall quality of life (SMD: 0.55, 95% CI: [0.07, 1.03], P=.03) in ESKD patients. While DHIs did not significantly improve overall self-efficacy(SMD: 0.56, 95% CI: [-0.06, 1.18], P=.08), subgroup analysis demonstrated a benefit in hemodialysis patients. ESKD patients exhibited favorable engagement and satisfaction with DHIs. Application-based interventions, telemedicine, and video interventions emerged as promising formats for improving the physical and mental health of ESKD patients. Due to high heterogeneity and a high risk of bias, the quality of the evidence was rated as moderate to very low.

Conclusions:

DHIs hold significant potential for improving the psychological health and quality of life of ESKD patients, particularly when tailored to patients' specific needs and delivered through interactive platforms like applications and telemedicine. However, the quality of the existing evidence is low, and these findings should be interpreted with caution. Future research should involve more high-quality RCTs, with DHIs design better meeting the unique needs of elderly patients, peritoneal dialysis patients, and kidney transplant recipients. Clinical Trial: The protocol was registered on PROSPERO (Registration number: CRD42024629357).