Effectiveness of Nursing and Non-Pharmacological Interventions in Reducing Intradialytic Hypotension Among Haemodialysis Patients: A Systematic Review and Meta-Analysis.

This study aimed to systematically evaluate the effectiveness of non-pharmacological interventions in reducing intradialytic hypotension among adult patients undergoing haemodialysis and to examine their implications for nursing practice. Systematic review and meta-analysis. PubMed, EMBASE, CINAHL, SCOPUS, DBpia and RISS were searched for studies published between January 2000 and July 2025. Randomized controlled trials and quasi-experimental studies evaluating non-pharmacological interventions were included. Methodological quality was assessed using Joanna Briggs Institute critical appraisal tools. Random-effects meta-analysis and subgroup analyses were conducted and certainty of evidence was evaluated using GRADE. Sixteen studies were included in the meta-analysis. Non-pharmacological interventions were associated with modest improvements in systolic blood pressure during haemodialysis, although substantial heterogeneity was observed. Dialysis technology-based interventions showed a significant improvement in systolic blood pressure, whereas nurse-led interventions showed a numerically similar effect but did not reach statistical significance. The overall certainty of evidence was very low. Non-pharmacological interventions may support haemodynamic stability during haemodialysis; however, improvement in systolic blood pressure represents a surrogate haemodynamic outcome and does not necessarily indicate a reduced incidence of intradialytic hypotension. Further well-designed studies using clinically meaningful and patient-centred outcomes are needed. Nurses can contribute to intradialytic hypotension prevention through assessment, monitoring, early recognition of haemodynamic instability, timely bedside interventions and patient education. The findings highlight the potential complementary roles of nurse-led care and dialysis technology-based approaches in the individualized management of adults undergoing haemodialysis. PRISMA 2020. Patients or members of the public were not involved because this study was a systematic review and meta-analysis of previously published studies. PROSPERO (CRD420251150743).