Impact of a nurse-led educational intervention on knowledge and adherence to hemodialysis in Kiambu County, Kenya: a quasi-experimental study

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Background Chronic kidney disease (CKD) affects approximately 13.4% of the global population, and many patients require maintenance hemodialysis (HD). However, adherence to the HD treatment regimen remains suboptimal and is associated with adverse clinical outcomes. This study assessed the effect of a nurse-led educational intervention on patients’ knowledge of and adherence to the HD treatment regimen. Methods A quasi-experimental study involving 129 patients undergoing maintenance HD was conducted between March and June 2025 at three dialysis centers in Kenya. Participants were followed for three months following the implementation of a nurse-led education intervention. Data were collected using a modified End-Stage Renal Disease Adherence Questionnaire (ESRD-AQ) and a structured knowledge questionnaire. Statistical analyses included paired and independent samples t-tests, McNemar and chi-square tests, and effect size estimation using Cohen’s d. Results In the intervention group, mean knowledge scores increased from 45.0% at baseline to 79.0% at endline, whereas only a modest increase was observed in the control group (43.0 to 46.0%). Adherence also improved significantly in the intervention group, with the proportion of participants achieving satisfactory adherence increasing from 18.5 to 69.6%, while no meaningful change was observed in the control group. Both within-group and between-group analyses demonstrated large intervention effects (Cohen’s d = 2.96 and 2.85, respectively). Conclusion The nurse-led educational intervention was associated with significant improvements in knowledge and adherence to the HD treatment regimen among patients undergoing maintenance HD. These findings suggest that structured patient education may be an effective strategy for enhancing treatment adherence and improving patient outcomes in resource-limited settings.

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