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

AIM: 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. DESIGN: Systematic review and meta-analysis. DATA SOURCES: PubMed, EMBASE, CINAHL, SCOPUS, DBpia and RISS were searched for studies published between January 2000 and July 2025. REVIEW METHODS: 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. RESULTS: 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. CONCLUSION: 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. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Nurses can contribute to intradialytic hypotension prevention through assessment, monitoring, early recognition of haemodynamic instability, timely bedside interventions and patient education. IMPACT: The findings highlight the potential complementary roles of nurse-led care and dialysis technology-based approaches in the individualized management of adults undergoing haemodialysis. REPORTING METHOD: PRISMA 2020. NO PATIENT OR PUBLIC CONTRIBUTION: Patients or members of the public were not involved because this study was a systematic review and meta-analysis of previously published studies. TRIAL AND PROTOCOL REGISTRATION: PROSPERO (CRD420251150743).