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

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.