Effect of a nurse-led, triangle-based hierarchical management model on patients undergoing maintenance hemodialysis: A randomized controlled trial.

BACKGROUND

Maintenance hemodialysis (MHD) imposes a high disease burden, leading to diminished quality of life (QoL) and poor treatment adherence. Conventional nursing often lacks individualized, risk-stratified strategies. This study aimed to evaluate the effectiveness of a nurse-led, Triangle-Based Hierarchical Management model on patient outcomes.

METHODS

In this prospective, single-center, cluster-randomized trial, 80 MHD patients were assigned to an observation group (n = 40) receiving the 24-week Triangle model intervention or a control group (n = 40) receiving routine care. The primary outcome was the change in Kidney Disease Quality of Life-Short Form (KDQOL-SF™) KDTA score. Secondary outcomes included self-management, adherence, knowledge, and hospitalization rates. Intention-to-treat analysis was performed using ANCOVA.

RESULTS

Seventy-one patients completed the study. The observation group demonstrated significantly greater improvement in the primary KDTA score compared to controls (mean difference: 7.59; 95 % CI: 3.54 to 11.64; P < 0.001). Significant improvements were also observed in self-management (mean difference: 6.63; 95 % CI: 3.10 to 10.16; P < 0.001) and treatment adherence (mean difference: 10.09; 95 % CI: 5.61 to 14.57; P < 0.001). Furthermore, the hospitalization rate was significantly lower in the observation group (11.1 % vs. 28.6 %; P = 0.048).

CONCLUSION

The nurse-led Triangle Hierarchical Management model significantly improved quality of life, self-management, and adherence, while reducing hospitalizations in MHD patients. These findings support the adoption of risk-stratified nursing models in chronic disease management.