Educational impact of a tablet application on nutrition in maintenance hemodialysis patients: A clinical pilot study

SUMMARY: Objective: To evaluate whether a novel, image-based quiz application used during dialysis sessions can improve electrolyte control and fluid balance in hemodialysis patients by enhancing dietary knowledge. Methods: In this single-center, non-randomized, open-label study, 49 maintenance hemodialysis patients of our dialysis center in Zurich (Switzerland) used a tablet-based quiz application during dialysis sessions over a four-week period. Dialysis was performed three times a week with a mean duration of 230 min. The app presented visual comparisons of food items regarding sodium, potassium, and phosphate content. Primary outcomes were changes in serum potassium and phosphate; ultrafiltration volume was a secondary outcome. Learning activity was assessed based on the number and accuracy of answers. All laboratory values were collected at the beginning of the week (Monday or Tuesday) after the long interval before dialysis began. The laboratory analyses were done in the hospital laboratory. Results: No statistically significant changes were observed in serum potassium (−0.038 mmol/L, P=0.542), phosphate (+0.083 mmol/L, P=0.115), or ultrafiltration volume (+67 mL, P=0.128). However, an increase in the proportion of correct answers (from 67.2% to 73.5%) indicated improved dietary knowledge. Conclusion: Although the digital intervention led to detectable effects in training intensity and knowledge, it did not translate into improvements in electrolyte levels or fluid balance. Patient motivation and engagement intensity may influence outcomes. Clinical trial registration number: NCT05111184 (Clinicaltrials.gov).