Effects of a structured nutrition education program on dialysis adequacy and clinical outcomes in maintenance hemodialysis patients

Objective: To evaluate the effects of a structured nutrition education program on dialysis adequacy, dietary intake, metabolic parameters, and quality of life in patients undergoing maintenance hemodialysis, and to determine whether responses differ according to baseline dialysis adequacy. Methods: In this multicenter prospective study, patients receiving maintenance hemodialysis were allocated by center to either a nutrition education group, in which a researcher from the team delivered the site's standard nutrition education protocol, or to standard care without protocolized nutrition education, and were followed for 9 months. Participants were stratified according to baseline Kt/V (<25th percentile, 25th-75th percentile, and >75th percentile). Clinical, nutritional, biochemical, and functional outcomes were assessed at baseline and after the intervention period. Between-group comparisons were performed within each Kt/V stratum. Results: A total of 105 patients were included in the final analyses. Baseline characteristics were generally comparable between intervention and control groups across Kt/V strata. The response to nutritional education differed according to baseline dialysis adequacy. Patients with lower baseline Kt/V showed significant post-intervention improvements in dietary composition, including lipid quality and selected micronutrient intakes. In the intermediate Kt/V group, the intervention was associated with improvements in energy intake balance, systolic blood pressure, and selected hematological parameters. Patients with higher baseline Kt/V demonstrated significant post-intervention improvements in dialysis adequacy (Kt/V), body weight, hematological indices, physical function, and quality of life. Conclusion: A structured nutrition education program was associated with differential clinical and nutritional effects in patients undergoing maintenance hemodialysis, depending on baseline dialysis adequacy. These findings highlight the importance of considering baseline Kt/V when designing and evaluating nutritional education interventions in the hemodialysis setting.