This study aims to evaluate the effect of an adaptive nutritional and educational intervention for patients on hemodialysis (HD) in a routine care setting, using real-world data from electronic health records. Decentralized clinical trial of seven HD facilities recruited patients who have been on HD for over 3months (N=153) for an 8-week adaptive intervention protocol. Patients were divided into four groups: (1) control (2) education intervention (3) meal intervention (4) education and meal interventions. Educational contents were digitally delivered via mobile phones and premade meals tailored on laboratory findings were home-delivered. Changes in serum electrolytes and malnutrition inflammation score (MIS) were analyzed. Meal intervention statistically significantly stabilized serum phosphorus level (β=-0.81mg/dL, 95% confidence interval=[-1.40, -0.22]) at week 8, with increased likelihood of being within target serum value range (odds ratio=1.21, 95% confidence interval=[1.04, 1.40]). Meal group showed better nutritional status (MIS=3.65) than the education group (MIS=5.10) at week 8 (adjusted p<.05). No significant changes were observed in serum potassium level, depression, and self-efficacy. It was demonstrated that an adaptive meal intervention in a real-world care setting may benefit serum phosphorus control and nutritional status of patients on HD, without negative effect on depression levels or self-efficacy. More work is needed to develop an effective educational intervention.