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Randomized clinical trial of 453 older adults with advanced kidney disease finds video decision aid increases advance care planning documentation to 56.6%

JAMA internal medicine (PubMed)Oct 22, 2026

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Brief summary

The VIDEO-KD randomized controlled trial of 453 older adults (mean age 78.8 years) with advanced kidney disease found that viewing a video decision aid combined with a patient declaration increased electronic health record advance care planning documentation from 40.0% to 56.6%.

What NurseJet pulled from the source

Older adults facing end-stage kidney failure must navigate complex, consequential decisions between hemodialysis, peritoneal dialysis, and conservative kidney management, yet advance care planning (ACP) remains underdocumented in routine ambulatory nephrology care. The multicenter VIDEO-KD parallel-group randomized clinical trial (ClinicalTrials.gov NCT04347629) enrolled 453 adults aged 65 years or older (mean age 78.8 +/- 6.4 years; 41.9% women) with advanced chronic kidney disease across 12 ambulatory clinics from June 2021 through March 2025. Participants were randomized to receive usual medical care (n = 225) or view a certified video decision aid detailing dialysis modalities and conservative kidney management paired with creating a personal goal declaration delivered to treating clinicians (n = 228). At 12-month follow-up, electronic health record ACP documentation confirmed by NLP-assisted human adjudication was significantly higher in the intervention cohort (56.6% vs 40.0%; rate difference 16.6%, 95% CI: 7.5%–25.7%; p < 0.001). Documented discussions of treatment options also increased significantly (46.1% vs 31.6%; rate difference 14.5%, 95% CI: 5.6%–23.4%; p = 0.001). Following the video intervention, the proportion of undecided patients fell from 41.3% to 13.2%, and 50.7% expressed a preference for conservative management versus 31.8% of controls (p < 0.001).

Why this matters for nurses

Geriatric, nephrology, and ambulatory care nurses frequently care for frail older adults who feel unprepared when kidney failure progresses, leading to emergent hemodialysis initiations that conflict with patient preferences. Demonstrating that an evidence-based video decision tool accompanied by patient-recorded goal statements substantially increases formal EHR advance care planning documentation empowers nurses to integrate multimedia decision aids into clinic visits, ensuring older adults treatment values are clarified and honored.

Bedside takeaway

In a 453-patient RCT of older adults with advanced kidney disease, a video decision aid increased electronic advance care planning documentation from 40.0% to 56.6% (p < 0.001).

Key takeaways

Multicenter RCT enrolled 453 older adults (mean age 78.8 years) with advanced CKD across 12 outpatient clinics.
Video decision aid plus patient declarations significantly increased 12-month ACP documentation from 40.0% to 56.6% (p < 0.001).
Documented clinician discussions of kidney failure modalities increased by 14.5 percentage points (46.1% vs 31.6%, p = 0.001).
Intervention reduced undecided patients from 41.3% to 13.2% and increased preference for conservative kidney management (50.7% vs 31.8%).
Structured video decision tools provide an accessible platform to elicit older patients values before acute dialysis crises arise.

Practice implications

Screen older adults with advanced renal disease for advance care planning status; offer validated decision aids to clarify goals regarding dialysis versus conservative care, and confirm that resulting preferences are formally documented in the electronic medical record.

Limitations & cautions

Outcome focused on electronic medical record documentation rather than longitudinal healthcare utilization, symptom burden, or goal-concordant end-of-life care; 82.8% of participants were White, requiring further evaluation in more diverse populations.
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JAMA internal medicine (PubMed)

JAMA internal medicine (PubMed). Video Decision Support and Advance Care Planning in Older Adults With Advanced Kidney Disease: The VIDEO-KD Randomized Clinical Trial.

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https://pubmed.ncbi.nlm.nih.gov/42911803/

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This summary does not replace clinical judgment, facility policy, provider orders, or official guidelines. Verify practice changes against the original source and local protocol.

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JAMA (PubMed)Oct 24, 2026Systematic Review

A systematic review and meta-analysis of 85 randomized controlled trials encompassing 70,543 participants found that SGLT2 inhibitor therapy was associated with small, statistically significant increases in hemoglobin (+0.60 g/dL), hematocrit (+2.36%), and erythropoietin (+2.11 mIU/mL).

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Systematic ReviewResearchMedication SafetyAI summary · original source linked below

Sodium-glucose cotransporter 2 (SGLT2) inhibitors are widely prescribed across chronic heart failure, type 2 diabetes, and chronic kidney disease, where retrospective observations frequently note concurrent elevations in red blood cell indices. In this systematic review and meta-analysis searching PubMed, Web of Science, and CENTRAL through July 22, 2026, researchers pooled data from 85 double-masked randomized clinical trials (median duration 24 weeks; IQR 12–32 weeks) covering 70,543 patients (mean age 62.4 +/- 9.4 years; 35.9% female). Seventy-eight trials compared SGLT2 inhibitors against placebo, and seven utilized active comparators (primarily sitagliptin). From baseline to follow-up, hemoglobin increased by 0.55 g/dL with SGLT2 inhibitors versus a 0.08 g/dL decrease in control cohorts (net between-group difference 0.60 g/dL, 95% CI: 0.55–0.66 g/dL; p < 0.001). Hematocrit changed by +2.17% versus -0.13% in controls (difference 2.36%, 95% CI: 2.19%–2.52%; p < 0.001). Analysis of secondary erythropoietic and iron parameters demonstrated a significant increase in serum erythropoietin (difference 2.11 mIU/mL, 95% CI: 0.50–3.71; p = 0.01) and a significant reduction in transferrin saturation (difference -0.84%, 95% CI: -1.21% to -0.47%; p < 0.001).

Key takeaways

Systematic review analyzed 85 double-masked RCTs encompassing 70,543 patients across cardiology, nephrology, and endocrinology.
SGLT2 inhibitors produced modest but statistically significant increases in hemoglobin (+0.60 g/dL) and hematocrit (+2.36%).
Therapy was associated with stimulated erythropoiesis, evidenced by an increase in serum erythropoietin (+2.11 mIU/mL, p = 0.01).
Transferrin saturation decreased slightly (-0.84%, p < 0.001), reflecting increased iron utilization during erythropoiesis.
Authors emphasized that clinical significance remains uncertain and SGLT2 inhibitors should not be prescribed for the primary intent of treating anemia.

Why this matters on shift

Nurses administer SGLT2 inhibitors (such as empagliflozin, dapagliflozin, and canagliflozin) daily on medical-surgical, cardiac, and renal units. When reviewing routine complete blood count panels, nurses observing slight elevations in hemoglobin or hematocrit must recognize this as a known physiologic class effect mediated by hemoconcentration and mild erythropoietin stimulation, rather than misinterpreting it as acute dehydration or treating SGLT2 inhibitors as an anemia cure.

Bedside takeaway

In a meta-analysis of 85 RCTs and 70,543 patients, SGLT2 inhibitors led to small increases in hemoglobin (+0.60 g/dL) and erythropoietin (+2.11 mIU/mL), though clinical significance is unclear.

Nursing implications

Anticipate modest increases in hemoglobin and hematocrit when monitoring patients on SGLT2 inhibitors; differentiate expected class-related hemoconcentration and erythropoietin stimulation from acute volume depletion, and continue reinforcing fluid balance and medication adherence.

Limitations & cautions

The observed hematologic elevations were small (+0.60 g/dL hemoglobin), and the clinical importance of these changes remains unproven; trials were not designed to test clinical anemia endpoints or symptomatic benefit; SGLT2 inhibitors are not approved for anemia therapy.
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Citations · exact source links

JAMA (PubMed). Sodium-Glucose Cotransporter 2 Inhibitor Use and Levels of Hemoglobin, Markers of Iron Metabolism, and Erythropoiesis: A Systematic Review and Meta-Analysis of Randomized Clinical Trials.

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Intensive & critical care nursing (PubMed)Oct 21, 2026Systematic Review

A systematic review and meta-analysis of 16 studies and 3,887 family participants found that while nurse-led support during the active ICU stay significantly reduced family depression, it did not significantly reduce short-term post-discharge anxiety, depression, or PTSD symptoms.

ICU LeadershipAI summaryReview source

Systematic ReviewResearchQuality ImprovementWorkflowAI summary · original source linked below

Family members of critically ill adult patients frequently develop post-intensive care syndrome-family (PICS-F), characterized by acute and long-lasting psychological trauma, anxiety, and depression. This systematic review and meta-analysis synthesized evidence from six major biomedical databases through May 2026 to evaluate nurse-led, continuity-oriented family support models. Seventeen reports representing 16 independent randomized and quasi-experimental trials and 3,887 family members were analyzed using random-effects models with Hedges g standardized mean differences (SMDs) and GRADE assessment. For primary short-term outcomes measured between two weeks and three months post-ICU discharge, nurse-led support was not associated with significant reductions in family anxiety (SMD -0.05, 95% CI: -0.24 to 0.14; very low certainty), overall depression (SMD -0.01, 95% CI: -0.23 to 0.21; very low certainty), or PTSD-related symptoms (SMD 0.02, 95% CI: -0.11 to 0.15; moderate certainty). However, subgroup analysis revealed that interventions delivered specifically during the active in-ICU phase produced a statistically significant reduction in family depression scores (SMD -0.40, 95% CI: -0.67 to -0.12). Nurse-type comparisons demonstrated no consistent performance differences between dedicated clinical nurse specialists and bedside nurses.

Key takeaways

Meta-analysis synthesized 16 trials including 3,887 family members of adult critical care patients.
Nurse-led support delivered during the in-ICU phase significantly lowered family depression scores (SMD -0.40, 95% CI: -0.67 to -0.12).
Across the broader post-ICU trajectory, nurse-led support did not significantly reduce short-term anxiety, depression, or PTSD symptoms.
Outcomes did not differ significantly between dedicated advanced practice nurses and unit bedside nurses.
Evidence certainty was moderate for PTSD and very low for anxiety and depression, underscoring the need for structured post-discharge mental health referral pathways.

Why this matters on shift

Critical care nurses spend extensive shift time communicating with, reassuring, and guiding families through acute life-threatening illnesses. Recognizing that in-unit nursing support meaningfully relieves immediate depressive distress—but that post-discharge psychological trauma persists without specialized multidisciplinary mental health follow-up—helps ICU teams optimize bedside communication while establishing realistic referral expectations for long-term PICS-F recovery.

Bedside takeaway

In a meta-analysis of 3,887 family members, nurse-led ICU support cut in-unit depression (SMD -0.40), but did not significantly alter post-discharge anxiety, depression, or PTSD.

Nursing implications

Provide compassionate, structured communication and daily updates to families during acute ICU care to reduce in-unit depressive symptoms; partner with hospital social work and psychology to arrange transitional support for families exhibiting high trauma risk.

Limitations & cautions

High methodological heterogeneity across intervention models; very few studies examined post-ICU ward transition phases; GRADE evidence certainty was very low for depression and anxiety outcomes.
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Citations · exact source links

Intensive & critical care nursing (PubMed). Nurse-led continuity-oriented family support across the adult ICU trajectory: a systematic review and meta-analysis of PICS-F-related outcomes.

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Medicina (Kaunas, Lithuania) (PubMed)Oct 17, 2026Research Article

The TOURNI-ED randomized controlled trial in 792 emergency department patients found that initiating cuff deflation as blood enters the first collection tube significantly reduced specimen hemolysis from 26.1% to 17.2% compared with late release.

Emergency Med-SurgAI summaryReview source

Research ArticleResearchWorkflowQuality ImprovementAI summary · original source linked below

In vitro hemolysis represents the leading preanalytical error in emergency department blood testing, frequently requiring specimen redraws and delaying critical diagnostic decisions. The single-center, parallel-group TOURNI-ED randomized trial (ClinicalTrials.gov NCT07617103) evaluated 792 adults triaged as Emergency Severity Index (ESI) 3 to 5 who underwent standardized direct 21-gauge venipuncture with 60 mm Hg cuff pressure. Participants were randomized 1:1 to early release (initiating cuff deflation when blood entered the first tube and completing deflation as that tube filled, n = 396) or late release (deflation after the final tube filled, n = 396). The primary complete-case analysis included 790 participants. Specimen hemolysis (hemolysis index >= 1+ in serum separator gel tubes) occurred in 17.2% (68/395) of the early-release group versus 26.1% (103/395) of the late-release group, demonstrating a statistically significant absolute risk reduction of 8.9 percentage points (95% CI: 3.1–14.5; p = 0.003; number needed to treat = 11.3; adjusted OR 0.58, 95% CI: 0.41–0.82). No early-release participant experienced venous stasis exceeding 60 seconds, compared with 29.0% in the late-release group. Phlebotomy-related complications occurred in 8.1% of early-release vs 5.6% of late-release patients (risk difference +2.5 points, 95% CI: -1.0 to 6.1).

Key takeaways

Single-center parallel-group RCT analyzed 790 adult emergency department patients triaged as ESI 3 to 5.
Early tourniquet deflation upon blood entering the first tube reduced hemolysis from 26.1% to 17.2% (p = 0.003).
Absolute risk reduction was 8.9 percentage points with a number needed to treat of 11.3 to avoid one hemolyzed sample.
Prolonged venous stasis (>60 seconds) was eliminated in the early release group (0% vs 29.0%).
Findings apply to direct 21-gauge venipuncture under 60 mm Hg cuff pressure and cannot be generalized to IV catheter blood draws or uncalibrated elastic bands.

Why this matters on shift

Emergency nurses and technicians draw dozens of blood specimens per shift under high-pressure conditions. Specimen hemolysis delays potassium, troponin, and coagulation results, necessitates repeat venipunctures, prolongs ED length of stay, and frustrates patients. Demonstrating that an immediate, cost-free workflow adjustment—releasing venous stasis as the first collection tube begins filling—substantially reduces specimen rejection gives bedside emergency nurses an actionable, evidence-based phlebotomy technique.

Bedside takeaway

In a randomized trial of 792 emergency patients, releasing tourniquet pressure once blood entered the first tube cut sample hemolysis from 26.1% to 17.2% (NNT = 11.3).

Nursing implications

When performing routine direct venipuncture in non-critical emergency patients, initiate tourniquet deflation immediately once blood flow is established into the primary tube rather than waiting until all collection tubes have filled.

Limitations & cautions

Single-center design restricted to non-critical acuity (ESI 3–5) undergoing direct 21-gauge venipuncture under 60 mm Hg sphygmomanometer pressure; findings cannot be generalized to resuscitation patients (ESI 1–2), blood draws through peripheral IV catheters, winged infusion sets, or standard elastic tourniquets.
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Citations · exact source links

Medicina (Kaunas, Lithuania) (PubMed). Effect of Early Tourniquet Release on Hemolysis in Emergency Department Phlebotomy: The TOURNI-ED Randomized Trial.

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Key takeaways

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More updates for this clinical area

Meta-analysis of 85 randomized trials and 70,543 patients links SGLT2 inhibitors to small increases in hemoglobin and erythropoietin

Meta-analysis of 3,887 family members shows nurse-led ICU support reduces in-unit depression but does not alter long-term anxiety or PTSD

Randomized trial of 792 emergency patients demonstrates early tourniquet deflation reduces blood sample hemolysis from 26.1% to 17.2%