Objective: To investigate the clinical effectiveness of need-based nursing interventions for hemodialysis patients with uremia. Methods: A double-blind, randomized controlled trial was conducted from January 2020 to June 2024, including a sample of 100 hemodialysis patients with uremia. The patients were randomly assigned into a test group (n = 50) and a control group (n = 50) using a random number table based on their medical record numbers. The control group received standard basic nursing care, while the test group received need-based nursing intervention. The two groups were compared based on self-care ability scores, resilience scores using the CD-RISC-10 scale, complication incidence rates, and nursing satisfaction. Results: After the nursing intervention, the test group showed significantly higher scores in self-care ability (P < 0.05) and CD-RISC-10 resilience (P < 0.05) than the control group. The incidence of complications was significantly lower (P < 0.05), and nursing satisfaction was notably higher (P < 0.05) in the test group compared to the control group. Conclusion: Need-based nursing for hemodialysis patients with uremia can enhance self-care abilities, improve psychological resilience, reduce complication rates, and increase nursing satisfaction, making it worthy of broader implementation.