A Hybrid Transition Program Combining Face-to-Face and Digital Approaches for Patients Newly Initiated on In-Center Hemodialysis: A Multicenter Quasi-Experimental Study.

Abstract

Purpose: The global increase in end-stage renal disease has led to more patients initiating hemodialysis. The transition to hemodialysis is a critical period characterized by lifestyle disruption and multidimensional adaptation. A successful transition is essential for sustaining long-term physical and psychological well-being. It requires adapting to new routines, forming supportive relationships, and developing self-management skills. This study evaluated the effectiveness of a hybrid transition program integrating face-to-face and digital components for patients newly initiated on in-center hemodialysis.

Methods: A multicenter quasi-experimental study was conducted at two dialysis centers in South Korea. Patients who had received hemodialysis for less than 36 months were recruited between December 2023 and March 2024. Of 57 participants, 30 were assigned to the intervention group and 27 to the control group. The intervention group participated in an 8-week hybrid program consisting of in-person education and mobile application support, while the control group received usual care. Data were collected at baseline (T0), post-intervention (T1), and 4-week follow-up (T2). The primary outcome was transition to hemodialysis. Secondary outcomes included dialysis symptoms, depression, quality of life, and clinical indicators (serum potassium, serum phosphorus, and interdialytic weight gain). Group-by-time effects were analyzed using repeated-measures ANOVA and generalized estimating equations.

Results: Significant group-by-time interactions were found for transition(p=.013), depression(p=.001), quality of life(p=.038), and interdialytic weight gain(p=.042). The intervention group showed improved transition and quality of life, with reduced depression and interdialytic weight gain. No significant differences were observed for dialysis symptoms or serum electrolyte levels.

Conclusions: The hybrid transition program improved patients' transition to hemodialysis, reduced depressive symptoms, enhanced quality of life, and decreased interdialytic weight gain. These findings suggest that hybrid approaches integrating digital and in-person support can serve as effective nursing strategies to promote successful transition in new hemodialysis patients.

Trial registration: Clinical Research Information Service (CRIS), KCT0009417.