<![CDATA[Background: Hemodialysis adequacy is a critical indicator of treatment success in chronic kidney disease (CKD) patients undergoing maintenance therapy. Although treatment adherence and hemodialysis vintage have individually been associated with dialysis outcomes, evidence regarding their combined influence on hemodialysis adequacy remains limited, particularly among Indonesian patients undergoing maintenance hemodialysis. Therefore, this study aimed to examine the association between treatment adherence, hemodialysis vintage, and hemodialysis adequacy. Methods: This study used an observational, cross-sectional analytical design. The study population comprised CKD patients undergoing routine hemodialysis at Dr. Saiful Anwar General Hospital. A sample of 102 respondents was selected using purposive sampling. Inclusion criteria included patients aged ≥18 years undergoing routine hemodialysis twice a week. The primary independent variables were treatment adherence and hemodialysis vintage. Age, sex, and vascular access were included as covariates in the multivariable logistic regression model. Data regarding adherence and hemodialysis duration were collected using observation sheets. Data were analyzed using the chi-square test and logistic regression at p<0.05. This study obtained ethical clearance under Number 400/117/K.3/102.7/2026. Results: Most respondents were aged 30–50 years (61.0%), male (68.0%), had good treatment adherence (54.9%), and had a hemodialysis vintage of ≥1 year (87.3%). Overall, 52.0% of respondents achieved adequate hemodialysis. Treatment adherence (OR = 5.855, 95% CI: 2.196–15.616, p < 0.001), hemodialysis vintage (OR = 6.532, 95% CI: 1.082–39.414, p = 0.041), and age (OR = 6.042, 95% CI: 2.146–17.012, p = 0.001) were independently associated with hemodialysis adequacy. Conclusion: These findings suggest that treatment adherence is an important modifiable behavioral factor associated with achieving adequate hemodialysis. At the same time, longer hemodialysis vintage and older age also independently contribute to favorable treatment outcomes. The results highlight the importance of integrating behavioral assessment and individualized supportive-educative nursing interventions into routine nephrology care to optimize hemodialysis adequacy.]]>
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