THE EFFECT OF TELE-NURSING PRACTICES ON QUALITY OF LIFE AND CLINICAL OUTCOMES IN PATIENTS WITH PREDIALYSIS CHRONIC KIDNEY DISEASE

Chronic kidney disease is a progressive and long-term health condition characterized by a gradual decline in kidney function and an increased risk of metabolic, cardiovascular, nutritional, psychosocial, and functional problems. The predialysis period, particularly stages 3A, 3B, and 4 chronic kidney disease, represents a critical phase in which appropriate education, lifestyle regulation, medication adherence, symptom monitoring, and regular follow-up may contribute to better disease management and delay the progression of renal dysfunction. During this period, patients are expected to follow complex recommendations related to nutrition, fluid intake, blood pressure control, medication use, physical activity, avoidance of nephrotoxic agents, symptom recognition, and timely health-seeking behaviors. However, many patients have difficulties in understanding and maintaining these behaviors in daily life. This may negatively affect quality of life, treatment adherence, self-care management, and clinical outcomes.

Predialysis patients often experience a high symptom burden, uncertainty about disease progression, fear of dialysis, limitations in daily activities, and reduced quality of life. In addition, changes in laboratory parameters such as estimated glomerular filtration rate, serum creatinine, blood urea nitrogen, potassium, phosphorus, calcium, sodium, albumin, hemoglobin, bicarbonate, and glycemic indicators may require continuous monitoring and individualized education. Patient education provided only during routine outpatient visits may not be sufficient for long-term behavioral change, especially because outpatient visits are usually short, clinic workload is high, and patients may forget or misunderstand the information provided. For this reason, structured, continuous, and nurse-led follow-up models are needed in the predialysis period.

Tele-nursing is a remote nursing care approach that uses telephone calls, messaging applications, video communication, digital education materials, reminders, and regular monitoring to support patients outside the hospital setting. Tele-nursing practices may increase access to nursing care, strengthen communication between patients and healthcare professionals, support medication adherence and self-care behaviors, and facilitate early identification of warning signs. In chronic disease management, tele-health and tele-nursing interventions have been increasingly used to improve patient education, treatment adherence, symptom control, and quality of life. In chronic kidney disease, remote follow-up may be particularly valuable because patients require long-term monitoring, repeated education, lifestyle modification, and timely referral when clinical deterioration occurs.

This study aims to evaluate the effect of tele-nursing practices on quality of life and clinical outcomes in predialysis patients with chronic kidney disease. The main objective of the study is to determine whether a structured tele-nursing program improves kidney disease-related quality of life compared with routine outpatient care. The secondary objectives are to evaluate the effects of the tele-nursing program on medication adherence, self-care management, blood pressure, body weight, edema status, and selected laboratory parameters. The study also aims to provide evidence regarding the feasibility and potential usefulness of nurse-led remote follow-up in patients who have not yet started dialysis treatment.

This study is planned as a randomized controlled experimental study with intervention and control groups and repeated measurements. The study population will consist of adult predialysis patients with stage 3A, 3B, or 4 chronic kidney disease who are followed in a nephrology outpatient clinic. Eligible participants will be assigned to either the tele-nursing intervention group or the control group. Data will be collected at three time points: baseline, the third month, and the sixth month. The study is expected to be conducted over a six-month follow-up period for each participant.