Mobile health application for adherence and symptom management in hemodialysis patients: a randomized controlled trial

Abstract Hemodialysis patients experience a heavy symptom burden that can undermine treatment adherence. This randomized controlled trial evaluated whether a mobile application-based training and counseling intervention reduces symptom burden and supports adherence. Sixty-eight patients at two hemodialysis centers in eastern Turkey were randomly allocated to intervention or routine care (n = 34 each). The application included five educational modules with text, images, and videos, two daily automated reminders, and researcher counseling provided within 8 h of a patient’s request. The primary outcome was symptom burden (Dialysis Symptom Index), the secondary outcome adherence (End-Stage Renal Disease Adherence Questionnaire); clinical, dialysis-related and biochemical parameters were exploratory. All 68 participants completed the 8-week follow-up. After adjustment for baseline values, symptom burden was lower (adjusted mean difference − 14.64, 95% confidence interval (CI) − 20.36 to − 8.92, P < 0.001) and adherence scores higher (75.24, 95% CI 28.04 to 122.44, P = 0.002) in the intervention group. Exploratory analyses favored the intervention for interdialytic weight gain (− 0.48 kg, P < 0.001), ultrafiltration volume (− 449.11 mL, P < 0.001), phosphorus (− 1.20 mg/dL, P = 0.017) and weight (− 0.62 kg, P = 0.003). Mobile application-based training and counseling may reduce symptom burden and support adherence; exploratory findings require confirmation in larger trials. ClinicalTrials.gov NCT05322291.