Discussion
HD, TG
This study aimed to compare the effects of the mHealth app use and face-to-face training on the clinical and laboratory parameters of dietary and fluid intake adherence in HD patients. This study showed that the mean IDWG in 48.57% of the patients was higher than 5.7% of their dry weight. The rate of fluid intake non-adherence was differ from 33.6 to 68.8% in different studies [This study also indicated that the patients’ dietary adherence was appropriate in terms of the serum P level before the intervention. Considering K, only 2.85% of the patients had poor dietary adherence. In the previous studies, the mean serum K and P levels in the patients before the intervention had been in the normal range [In the present study, the serum TC and TG levels respectively in 57.14% and 64.28% of the HD patients were higher than normal, and they had poor dietary adherence. Saini et al. found that the mean baseline serum TC and TG levels in the patients undergoing HD had been out of the normal range [In this study, the serum AL and FER levels were out of the normal range in 22.85% and 59.99% of patients, respectively, and they showed poor dietary adherence in this line. Significantly, the HD patients had self-administered ferritin-boosting medications. ​It seems that the main reason for the decrease in the mean serum FER level after the intervention in this study was the training provided regarding the side effects of taking such medications with no consultation. Similar results had been further reported, wherein the serum FER level in the patients had dropped after the administration of oral vitamin C supplements, and their need for erythropoietin-stimulating agents (ESAs) had dwindled [​Both training methods did not significantly reduce the mean IDWG and the serum K, P, and TC levels in the patients. Clinically, the changes were more significant in the group trained with the Di Care app. Unlike face-to-face training, the Di Care app use reduced the serum TG level, increased AL, and modulated the serum FER level in the patients. Both methods promoted dietary and fluid intake adherence in the patients, which could significantly improve dietary and fluid intake adherence in the mHealth group.In the present study, the mean IDWG and the serum TC and TG levels subsided in a significant manner in the patients trained with the Di Care app. The serum AL level also significantly dropped, but FER was adjusted. Despite the descending trend in the mean values of K and P, this decrease was not significant. Training HD patients by sending text messages in a study revealed that the mean serum P and K levels had diminished after the intervention but the IDWG had not significantly decreased [This study showed a decrease in the mean serum K and P levels in the HD patients receiving face-to-face training, which was not statistically significant. These results agreed with the reports in Jahanpeyma et al. [