impact of family-centered empowerment on laboratory outcomes in hemodialysis: a quasi-experimental study

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.