Short-term effectiveness of telehealth interventions for people in maintenance dialysis: differential impacts on clinical outcomes by modality and intervention type - a systematic review and meta-analysis

This systematic review and meta-analysis aimed to evaluate the effects of telehealth interventions compared with usual care on clinical indicators during the initial 3 months among adults receiving peritoneal dialysis (PD) or hemodialysis (HD) and to investigate whether different telehealth intervention models produce differentiated outcomes. Following PRISMA guidelines, a comprehensive search of eight databases was conducted for randomized controlled trials (RCTs) published until August 2024, involving adult dialysis patients receiving telehealth interventions versus usual care. Outcomes were serum albumin, serum creatinine, hemoglobin, and hematocrit measured at approximately 3 months. Data were analyzed using random-effects models, subgroup analyses, and GRADE for evidence quality assessment. Five RCTs involving 1455 screened articles were included. Telehealth interventions were associated with changes in serum creatinine in both HD (MD = −80.45; 95% CI −136.63, −24.27) and PD patients (MD = −162.67; 95% CI −193.09, −132.25). Hemoglobin levels improved notably in PD patients (MD = 8.66; 95% CI 5.89, 11.42), but not in HD patients. Subgroup analyses showed that education-only interventions increased hemoglobin (MD = 6.68; 95% CI 2.30, 11.05; I2 = 0%; p = 0.003). Education-only models indicated short-term improvements in certain laboratory markers; results for education + monitoring were mixed. High heterogeneity (I2 ≥ 75%), limited number of studies, small sample sizes, regional restrictions, and low-quality evidence reduced certainty. Telehealth interventions may provide short-term benefits for specific clinical indicators in maintenance dialysis for PD. Future large-scale, multicenter trials with extended follow-up are needed to clarify optimal telehealth strategies and determine how best to integrate telehealth into routine practice. The study protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO) at the National Institute for Health Research (CRD: 42024574257). Not applicable.