Impact of Family-Centered Empowerment on Laboratory Outcomes in Hemodialysis: A Quasi-experimental Study

Abstract

Background: Disturbances in serum calcium, phosphorus, blood urea nitrogen (BUN), and creatinine drive morbidity in maintenance hemodialysis. The Family-Centered Empowerment Model (FCEM) seeks to translate education into durable adherence and improved biochemical control. Objectives: To examine whether a nurse-led FCEM program is associated with more favorable short-term trajectories in calcium, phosphorus, BUN, and creatinine among adults on hemodialysis. Methods: Two-arm, single-center quasi-experimental study with convenience sampling and shift-based allocation (intervention = afternoon; control = morning). N = 100 (n = 50/group). The intervention comprised four weekly 90-minute small-group sessions delivered by the same nurse with a primary family caregiver present (perceived threat; problem-solving/self-efficacy; participatory education/teach-back; evaluation). Controls received usual care during follow-up. Laboratory outcomes (serum calcium, phosphorus, BUN, creatinine) were abstracted at three time-points: Baseline, 1 month, and 2 months. Analyses used independent t-tests and chi-square tests for baseline comparisons and repeated-measures ANOVA for time×group effects (α = 0.05; Shapiro–Wilk for normality; Greenhouse–Geisser when sphericity was violated). Results: Baseline age was similar between groups (control 47.24 ± 16.14 years; intervention 48.18 ± 15.78 years), as was sex; the primary caregiver relationship differed (P = 0.006). Over two months, the intervention group showed calcium rising 8.10→8.90→9.50 mg/dL (control 8.30→8.30→8.40; between-group P at 1 month and 2 months both < 0.001); phosphorus falling 5.10→5.10→3.90 mg/dL (control 5.10→5.20→5.40; 1 month and 2 months both P < 0.001); BUN decreasing 69.14→57.15→48.95 mg/dL (control 67.41→66.39→68.98; P = 0.01 at 1 month; P < 0.001 at 2 months); and creatinine decreasing 8.47→7.64→7.34 mg/dL (control 8.84→7.94→7.94; P = 0.009 at 1 month; P < 0.001 at 2 months). Time × group interactions were significant for all endpoints (all P < 0.001). Longitudinal plots illustrate these trends. Conclusions: A brief, nurse-led family-centered empowerment program was associated with more favorable 2-month trajectories—higher calcium and lower phosphorus, BUN, and creatinine—than usual care. Embedding FCEM with trend-based monitoring and caregiver teach-back may help dialysis units move toward recommended biochemical targets.