Abstract
BACKGROUND: End-stage kidney disease (ESKD) imposes a significant global health burden, with patients often experiencing poor quality of life (QoL) due to psychological distress and low self-efficacy. Digital health interventions (DHIs) offer potential to address these challenges. However, their effects in this population remain inconsistent, and a comprehensive synthesis of the evidence is lacking. OBJECTIVE: The present study aims to assess the impact of DHIs on the psychological health, self-efficacy, and QoL of patients with ESKD and to evaluate engagement, adherence, and satisfaction with these interventions. 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 DHIs on psychological health, self-efficacy, or QoL in patients with ESKD were included. Two reviewers independently screened studies, extracted data, and assessed the risk of bias using the Cochrane Risk of Bias Tool (RoB 2). A meta-analysis was performed using Review Manager 5.4, with subgroup analyses by treatment modality, intervention type, and duration. Evidence quality was assessed using the Grading of Recommendation, Assessment, Development, and Evaluation (GRADE) approach. RESULTS: Twenty-three RCTs involving 2407 patients with ESKD from 12 countries were included. DHIs significantly improved depression (standardized mean differences [SMD] -0.41, 95% CI -0.63 to -0.19, P=.003) and overall QoL (SMD 0.55, 95% CI 0.07-1.03, P=.03). While DHIs did not significantly improve overall self-efficacy (SMD 0.56, 95% CI -0.06 to 1.18, P=.08), a benefit was observed in patients on hemodialysis (SMD 0.59, 95% CI 0.34-0.83, P<.001). Engagement was favorable, with completion rates above 63%, adherence rates of 54%-79%, and generally positive patient feedback on DHIs. Application-based interventions improved self-efficacy (SMD 0.66, 95% CI 0.31-1.02, P<.001) and overall QoL (SMD 0.50, 95% CI 0.04-0.96, P=.003); telemedicine improved depression (SMD -0.88, 95% CI -1.21 to -0.56, P<.001) and self-efficacy (SMD 2.76, 95% CI 2.32-3.20, P<.001); and video-based interventions improved depression (SMD -0.34, 95% CI -0.55 to -0.13, P=.002) and overall QoL (SMD 0.31, 95% CI 0.15-0.46, P<.001). Due to high heterogeneity and risk of bias, evidence quality was rated as low for depression and overall QoL, moderate for general anxiety, and very low for stress and self-efficacy. CONCLUSIONS: DHIs can significantly improve the psychological health and QoL of patients with ESKD, particularly when tailored to patients' needs and delivered through interactive platforms such as apps and telemedicine. High engagement and positive patient feedback suggest good acceptability in clinical practice. However, low evidence quality warrants cautious interpretation. Future research should involve more high-quality RCTs and design DHIs that address the unique needs of older patients, patients on peritoneal dialysis, and kidney transplant recipients.