Purpose: This study was to examine the relationships between knowledge with same sub-areas of education needs and adherence to self-management guidelines, and to investigate the factors that influence adherence. Method: One hundred eleven patients with terminal stage of kidney failure were conveniently selected from a university hospital in Incheon. Results: The level of knowledge was high, with a mean score of 15.25. The level of adherence to self-management guidelines was low, with a mean score of 64.53. The patients’ education needs were high. The significant influencing factors on adherence were gender, educational level, and two sub-areas of knowledge, ‘exercise and daily life’ and ‘follow-up care and treatment’. Conclusion: Relationships between knowledge, education needs, and adherence should be further examined before developing and implementing intervention programs for adherence to treatment guideline in hemodialysis patients.