Nurse-Led and Multidisciplinary Interventions for the Prevention and Early Identification of Foot Complications in Adults on Dialysis: A Systematic Review

Background: Foot complications in adults undergoing dialysis are common and may lead to ulceration, infection, peripheral artery disease, amputation, hospitalization, and reduced quality of life. Dialysis nurses may support prevention through regular surveillance, education, and timely referral, but evidence remains inconsistent. Objective: To assess the effectiveness of nurse-led or multidisciplinary interventions with a nursing component for preventing and identifying foot complications in adults receiving dialysis, and to explore costs, resource use, and organizational outcomes. Methods: This systematic review followed PRISMA reporting guidance. PubMed/MEDLINE, Embase, CINAHL, Scopus, Google Scholar and ClinicalTrials.gov were searched. Eligible quantitative studies were appraised using JBI criteria and certainty assessed with GRADE. Findings were synthesized narratively. Results: Six studies were included, all in haemodialysis. Educational findings were mixed: one study reported six-month increases in Knowledge of Foot Care (2.85 to 8.52/10) and Nottingham Assessment of Functional Footcare scores (37.85 to 75.56/87; both p < 0.001), whereas a controlled comparison showed no significant knowledge difference (15.30 versus 14.33/20; p = 0.41). Increased nurse foot checks were reported, but behavioural changes were independent of intervention timing. Historical cohorts differed in footwear appropriateness (59% versus 37%) and sensory neuropathy prevalence (52% versus 88%). Service evaluations described surveillance and referral activity; economic data were descriptive. Certainty was very low across assessed outcome domains. Conclusions: Nursing and multidisciplinary pathways may support foot-care delivery in haemodialysis, but effects on major clinical outcomes remain uncertain. Robust controlled studies are needed.