The impact of advanced nurse practitioners on patient outcomes in chronic kidney disease: A systematic review.

BACKGROUND: Management of individuals with chronic kidney disease (CKD) requires a collaborative approach. Nurses have diversified their skills to take on roles which have been traditionally physician-led. The impact of such roles, mainly that of the advanced nurse practitioner (ANP), has not been previously assessed using a systematic approach.

OBJECTIVES: The aim of this systematic review (SR) was to determine the impact of the addition of an ANP on patient outcomes in adults with CKD.

DESIGN: A SR, following the guidance of PRISMA was undertaken.

METHODS: Population: adults with CKD.

INTERVENTION: ANP. Databases searched included The Cochrane Library, Cumulative Index to Nursing and Allied Health Literature, Embase and Medline.

MEASUREMENTS: Outcome measures were blood pressure (BP), lipids, haemoglobin A1c (HbA1c), phosphate and parathormone (PTH) measures and recommended medication use.

RESULTS: Four studies met the inclusion criteria. All possessed external validity and demonstrated low risk for random sequence generation and allocation concealment but were at high risk of performance bias and detection bias. The addition of an ANP resulted in the superior management of BP in all studies. Three studies reported improved control of low-density lipoprotein (LDL) and PTH. One study reported greater achievement of phosphate control. Glycaemic control was equal in both groups. All studies reported higher rates of recommended medication use.

CONCLUSION: The addition of an ANP is superior or equal to the usual care models for the management of BP, LDL, PTH and glycaemic control in adults with CKD.