Efficacy of a Traffic Light Diary in Volume Management for Patients Undergoing Maintenance Hemodialysis: A Randomized Controlled Study

OBJECTIVE: To investigate the efficacy of a traffic light diary in volume management for patients undergoing maintenance hemodialysis. METHODS: A total of 80 patients undergoing maintenance hemodialysis were enrolled and randomly assigned using a random number table to either an intervention group (n = 40) or a control group (n = 40) for a 12-week intervention period. The control group received routine hemodialysis treatment and health education on volume management in the hemodialysis unit. The intervention group additionally implemented volume management based on a traffic light diary. Comparisons were made between the two groups regarding before and after the intervention scores on the knowledge, attitude, and practice scales for volume management. The volume management compliance rate, interdialytic weight gain, ultrafiltration rate, and blood pressure levels were statistically analyzed. Acute dialysis complications during the intervention period were recorded and statistically evaluated for both groups. RESULTS: Before the intervention, there were no statistically significant differences between the two groups in terms of fluid management knowledge, attitude, and practice scores; fluid management compliance rate; or blood pressure levels (all p > 0.05). After the intervention, the intervention group scored significantly higher than the control group in knowledge (median [IQR]: 9 [8-10] vs. 7 [6-8]), attitudes (9.2 [8.5-10.0] vs. 7.0 [6.1-8.2]), and practice (22.9 ± 1.62 vs. 18.7 ± 1.01) (all p < 0.05). The fluid management compliance rate was 95% in the intervention group, which was significantly higher than the 75% in the control group (p < 0.05). Interdialytic weight gain and ultrafiltration rate decreased significantly in the intervention group compared with the control group (p < 0.05). Blood pressure control was also superior in the intervention group compared to the control group (p < 0.05). The incidence of acute intradialytic complications, namely hypotension and muscle cramps, was significantly lower in the intervention group than in the control group (p < 0.05). CONCLUSION: The implementation of fluid management based on a traffic light diary, which combines self-monitoring feedback with professional health education, is of significant importance for improving patients' knowledge, attitude, and practice regarding fluid management, enhancing fluid management efficacy, stabilizing blood pressure levels, and reducing the incidence of acute intradialytic complications.