Pharmacological and Nutraceutical Interventions for Managing Complications in Chronic Hemodialysis Patients: A Scoping Review

Abstract

Context: Patients receiving chronic hemodialysis experience a wide spectrum of complications driven by persistent oxidative stress, inflammation, metabolic abnormalities, and neurological disturbances. As interest in pharmacological and nutraceutical interventions increases, a comprehensive mapping of the existing evidence is needed to clarify therapeutic potential and guide future research. Evidence Acquisition: This scoping review followed the Arksey and O'Malley framework and the Joanna Briggs Institute methodology. A comprehensive search of PubMed, Scopus, Web of Science, Embase, Cochrane Library, Google Scholar, and medRxiv was conducted to identify studies published between January 1, 2000, and December 31, 2025. Eligible studies included clinical trials and observational studies evaluating pharmacological or nutraceutical interventions in adult hemodialysis patients. Two reviewers independently performed study selection and data extraction using predefined PCC-based eligibility criteria. Extracted data included study characteristics, intervention details, targeted complications, and outcomes. An optional quality appraisal was conducted using the Mixed Methods Appraisal Tool. Owing to heterogeneity across studies, findings were synthesized narratively. Results: A total of 18 studies met the inclusion criteria and were included in the final analysis. Interventions such as omega-3 fatty acids and gabapentin were associated with improvements in uremic pruritus, whereas melatonin was associated with improved sleep quality and regulation of circadian rhythms. Antioxidant therapies, including N-acetylcysteine, vitamin C, coenzyme Q10, alpha-lipoic acid, and green tea extract, were reported to reduce oxidative stress markers; however, effect sizes varied by dosage, duration, and study design. Evidence for cardiovascular and metabolic outcomes remained limited, and several clinically important complications, including arrhythmias, were inadequately studied. Substantial heterogeneity in outcome measures limited cross-study comparisons. Conclusions: Pharmacological and nutraceutical interventions show potential for managing several hemodialysis-related complications, particularly pruritus, sleep disturbances, and oxidative stress. However, the evidence base is limited by small sample sizes, methodological heterogeneity, and inconsistent reporting. Future research should prioritize large, rigorously designed randomized trials, standardized outcome frameworks, and broader geographic representation to improve the generalizability of the findings and support more effective patient-centered care.