The Effectiveness of Peer Support on Self-Management and Psychosocial Outcomes in Maintenance Hemodialysis Patients:...

Patients undergoing maintenance hemodialysis frequently encounter a substantial psychosocial burden, yet conventional care frequently lacks the capacity to deliver comprehensive, sustained psychosocial support due to limitations in resources. Nurse-led peer support, which integrates professional expertise with the lived experience of peers, presents a promising complementary model; however, its consolidated efficacy in this population lacks rigorous synthesis.

This systematic review and meta-analysis aimed to evaluate the effects of nurse-led peer support on self-management, psychological status, and quality of life in patients receiving maintenance hemodialysis.

This review systematically searched ten databases (PubMed, Web of Science, Embase, CINAHL, Cochrane Library, Scopus, CNKI, WanFang, VIP, and SinoMed) from their inception to 20 January 2025 for randomized controlled trials and quasi-experimental studies. A meta-analysis was performed using random-effects models to pool standardized mean difference (SMD). The quality assessment and meta-analysis were conducted utilizing the Cochrane RevMan 5.4 software, with the evidence quality being evaluated employing the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) system. The present study is registered in PROSPERO with the registration number CRD42025639997.

A total of 292 literature records were retrieved, among which 27 studies met the inclusion criteria, and 11 provided data suitable for analysis (n = 1074). The overall risk of bias was thus determined to be low to moderate. Peer support demonstrated significant benefits for self-management (SMD = 0.77, 95% CI: 0.60-0.94; I² = 35%), quality of life (SMD = 0.91, 95% CI: 0.50-1.32; I² = 77%), and depression (SMD = -0.87, 95% CI: -1.39-0.36; I² = 70%). Evidence from two studies suggests that anxiety may be alleviated. The certainty of evidence was moderate for most outcomes.

This systematic review and meta-analysis indicates that nurse-guided peer support improves self-management capabilities and quality of life among maintenance hemodialysis patients while alleviating depressive and anxiety symptoms. Due to the limited number of included studies and heterogeneity in intervention protocols, implementation formats, and supporter criteria, the certainty of evidence is mostly moderate. However, consistent results support the positive clinical benefits of this intervention. Therefore, integrating structured peer support into routine care systems represents an effective complementary strategy. Future research should focus on identifying key factors influencing its efficacy, developing standardized intervention protocols, and validating the effectiveness and sustainability of blended online-offline delivery models.