Aim <p>This study compared fluid control, dietary adherence, and interdialytic weight gain (IDWG) between fasting and non-fasting hemodialysis (HD) patients during Ramadan.</p> Materials and methods <p>This quasi-experimental study, data were collected from 128 HD patients (56 fasting, 72 non-fasting) at a single center. Pretest data were gathered 1&#xa0;month before Ramadan, and post-test data on the final day of Ramadan. Data collection tools included a Patient Information Form, the Fluid Control in Hemodialysis Patients Scale (FCHPS), and the Dialysis Diet and Fluid Non-adherence Questionnaire (DDFQ).&#xa0;Data were analyzed using paired and independent samples t-tests.</p> Findings <p>A significant time-by-group interaction was observed.&#xa0;Fasting patients showed a significant decrease in IDWG from pretest to posttest (<i>p</i> &lt; 0.05), whereas non-fasting patients maintained more stable IDWG. However, fasting patients also demonstrated a significant decline in FCHPS total scores and its Knowledge, Behavior, and Attitude subscales (<i>p</i> &lt; 0.05), indicating poorer fluid management adherence and awareness. DDFQ scores also indicated poorer dietary adherence in the fasting group compared to the non-fasting group.</p> Conclusion <p>Fasting patients were found to have lower adherence to fluid management, and their knowledge, behavior, and attitudes were negative. Non-fasting patients were found to have higher adherence to fluid management, diet, and fluid management than fasting patients.</p>