Impact of Advanced Practice Nurses on the Outcomes of Individuals With Chronic Kidney Disease: A Systematic Review

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Abstract
Aim: To examine the association between advanced practice nursing roles and outcomes among individuals with chronic kidney disease. Background: Chronic kidney disease presents major health challenges. Advanced practice nurses in nephrology can improve patients’ quality of life and reduce health‐care costs, although inconsistent findings in the literature have hindered widespread adoption of such nursing. Design: A systematic review following the Cochrane Collaboration guidelines. Search Strategy: Randomized controlled trials on advanced practice nurses and individuals with chronic kidney disease were included. Databases (PubMed, Web of Science, CINHAL, Embase, Cochrane Database, Joanna Briggs Database, and Scopus) were searched from inception to November 2025. Results: Eight randomized controlled trials and one secondary analysis were included. The roles of advanced practice nurses were delineated into two models: a collaborative model of management with physicians and an extended model of leading specific interventions. Thirty‐two outcomes were identified, comprising 31 patient outcomes and one organizational outcome. Positive effects were observed for certain patient outcomes, including blood pressure control, renal endpoint reduction, and patient experience; however, these findings were inconsistent across studies. No significant effects were found for organizational outcomes. Conclusion: Advanced practice nurses demonstrate potential for improving selected patient outcomes in patients with chronic kidney disease, although evidence for organizational outcomes remains limited. Implications for Nursing: Policymakers and hospital administrators should explore care models for individuals with chronic kidney disease and expand the scope of practice for advanced practice nurses. Implications for Health Policy: Policymakers should clarify the scope of practice and prescribing authority for advanced practice nurses, establish sound certification and continuing education systems, develop reasonable reimbursement mechanisms, and promote standardized interprofessional collaboration.

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