The effect of nutrition education interventions on dialysis patients' outcomes: a systematic review and meta-analysis

Clinical Snapshot

Key Findings

• P Value: Statistically significant for knowledge, QoL, potassium, and phosphate outcomes

• Effect Size: Large effect sizes for knowledge and quality of life; small to moderate effects for biochemical markers

• Primary Outcome: Nutrition education significantly improved nutritional knowledge (SMD = 1.09; 95% CI: 0.67-1.51) and health-related quality of life (SMD = 1.43; 95% CI: 0.86-2.00)

• Nnt Or Sensitivity: Effect sizes suggest clinically meaningful improvements in knowledge and quality of life, with modest biochemical benefits

• Confidence Interval: Knowledge: 0.67-1.51; QoL: 0.86-2.00; Potassium: -0.91 to -0.14; Phosphate: -0.56 to -0.15

Clinical Application

Nutrition education interventions appear feasible across different formats and settings, though optimal delivery methods remain unclear Relevant to Australian dialysis services and aligns with RACGP chronic kidney disease guidelines emphasizing patient education. Could inform Medicare-funded dietitian consultations and support Kidney Health Australia initiatives Adult dialysis patients in various healthcare settings, though heterogeneity limits precision of effect estimates

Abstract

BACKGROUND: Non-adherence to dietary and fluid restrictions among dialysis patients is associated with adverse clinical outcomes. Quantifying the effectiveness of nutrition education interventions can inform practice and policy. METHODS: We searched MEDLINE, EMBASE, CINAHL, CENTRAL, PsycINFO, Web of Science, and Scopus up to 15 July 2025, supplemented by trial registries and Google Scholar, with an updated search through 8 April 2026. Eligible studies included randomized and non-randomized trials evaluating nutritional education interventions in adult dialysis populations. Risk of bias was assessed using RoB-2 and ROBINS-I, certainty graded using GRADE, and random-effects meta-analyses conducted alongside subgroup, sensitivity, and meta-regression analyses. Publication bias was assessed with Egger and Begg tests and trim-and-fill where applicable. RESULTS: Forty-four studies comprising 4,106 participants were included. Nutrition education significantly improved knowledge (SMD = 1.09; 95% CI: 0.67-1.51) and health-related quality of life (SMD = 1.43; 95% CI: 0.86-2.00; I² = 0%), and reduced serum potassium (SMD = -0.52; 95% CI: -0.91 to -0.14; I² = 92%) and serum phosphate (SMD = -0.35; 95% CI: -0.56 to -0.15; I² = 81%). Results for albumin, creatinine, sodium, calcium, and BUN were inconsistent and non-significant. Most outcomes were rated low or very low certainty by GRADE, reflecting inconsistency, indirectness, and imprecision. Potential publication bias was identified for certain outcomes. CONCLUSIONS: Nutrition education consistently improves knowledge and quality of life and may modestly reduce serum phosphate and potassium in dialysis patients. High-quality registered trials with standardized outcomes and longer follow-up are needed to establish effectiveness and sustainability. PROSPERO REGISTRATION: CRD420251119567.

References

1. 1.Sarmadi, S., Sanaie, N., & Zare-Kaseb, A. (2026). The effect of nutrition education interventions on dialysis patients' outcomes: a systematic review and meta-analysis. Annals of Medicine. https://doi.org/10.1080/07853890.2026.2660389