Association of Optimized Nursing Care with Clinical and Patient-Reported Outcomes in Maintenance Hemodialysis Patients: A Retrospective Before-After Study.

OBJECTIVE

To evaluate the association of optimized nursing care with clinical and patient-reported outcomes in maintenance hemodialysis patients.

METHODS

This single-center retrospective before-after study included 112 maintenance hemodialysis patients treated between January 2022 and December 2024. Patients in the conventional care period (January 2022-June 2023; n=53) received standard hemodialysis nursing care, whereas patients in the optimized care period (July 2023-December 2024; n=59) received structured optimized nursing care incorporating risk stratification, standardized complication prevention, health education, self-management support, and psychosocial screening. Outcomes included dialysis adequacy, complications, hospitalization, laboratory indicators, quality of life, psychological status, patient satisfaction, and nursing care quality scores.

RESULTS

After adjustment for age, sex, BMI, dialysis vintage, comorbidities, and vascular access type, the optimized care period was associated with higher Kt/V (β=0.102, 95% CI: 0.042-0.161, P=0.001), higher KDQOL-SF scores (β=8.980, 95% CI: 5.271-12.689, P<0.001), lower hospitalization frequency (IRR=0.654, 95% CI: 0.465-0.921, P=0.015), lower HADS-Total scores (β=-4.036, 95% CI: -5.188 to -2.884, P<0.001), and higher PSQ-18 scores (β=8.006, 95% CI: 4.795-11.217, P<0.001). The adjusted association with overall complication occurrence was not statistically significant (OR=0.443, 95% CI: 0.106-1.857, P=0.265). Nursing care quality scores were moderately correlated with KDQOL-SF (r=0.448, P<0.001) and weakly correlated with Kt/V (r=0.271, P=0.004).

CONCLUSION

In this single-center retrospective before-after study, optimized nursing care was associated with better dialysis adequacy, quality of life, psychological status, patient satisfaction, and hospitalization outcomes. Given the observational design and possible temporal confounding, prospective multicenter studies are needed to confirm these findings.