Effectiveness of a Nurse-Led Interventions on Dietary and Fluid Adherence among Patients with Hemodialysis

Abstract

Background: Adapting lifestyle behaviors through appropriate regulation of dietary and fluid intake is a fundamental component in caring for patients with end-stage renal disease (ESRD) receiving hemodialysis. However, maintaining adherence to prescribed dietary and fluid restrictions remains a persistent daily challenge for many patients and may adversely affect treatment outcomes.

Objective(s): Hemodialysis patients require strict adherence to dietary and fluid restrictions to prevent serious metabolic and cardiovascular complications. However, The present study was conducted to evaluate the effectiveness of a nurse-led interventions on adherence to dietary and fluid among adults with hemodialysis.

Methods:  A quasi-experimental pre-posttest design was conducted from November 2025 to February 2026 at the Dialysis Unit of the Renal Disease and Transplantation Center, Al-Najaf Al-Ashraf City/Najaf Health Directorate. A non-probability consecutive sample of 80 patients undergoing hemodialysis was recruited for the study. Data were collected using a validated dietary and fluid adherence questionnaire. The collected data were analyzed using descriptive statistics through the Statistical Package for the Social Sciences (SPSS), version 26.

Result: One month after the implementation of the intervention, the study group demonstrated a significantly higher total adherence score than the control group. The nurse-led intervention was associated with an improvement in patients' adherence, with overall adherence shifting from a low to a moderate level, while the proportion of patients achieving good adherence was greater in the study group. Furthermore, participants in the intervention group showed significantly lower serum phosphorus (4.16 ± 0.66 vs. 6.93 ± 1.21 mg/dL), serum potassium (5.17 ± 0.66 vs. 6.74 ± 1.08 mmol/L), and interdialytic weight gain compared with those in the control group. Collectively, these findings indicate that nurse-led interventions are effective in enhancing adherence behaviors and improving selected clinical outcomes among patients undergoing hemodialysis.

Conclusion: The results of this study indicate that nurse-led interventions enhance adherence among hemodialysis patients and improve selected clinical indicators.