Health-related quality of life in patients on maintenance hemodialysis: Evidence from southern Iran using EQ-5D-5L and KDQOL-SF.

Abstract

Hemodialysis (HD) is a common treatment for end-stage renal disease (ESRD) but is often accompanied by markedly reduced health-related quality of life (HRQoL). This study aimed to assess HRQoL and its determinants among HD patients. In this cross-sectional study, 203 adult HD patients in Bandar Abbas, Iran, were evaluated. HRQoL was measured via the EQ-5D-5 L index, EQ-VAS, and SF-12 physical (PCS) and mental (MCS) component summary scores. Multivariable linear regression models, identified factors significantly associated with HRQoL. The mean (SD) EQ-5D-5 L index, EQ-VAS, PCS, and MCS scores were 0.50 (0.47), 64.9 (23.7), 42.3 (8.1), and 42.3 (9.0), respectively. Individuals with higher levels of education demonstrated significantly better EQ-5D-5L index scores (β: 0.24, 95% CI: 0.06 to 0.41 for <6 classes; β: 0.22, 95% CI: 0.03 to 0.40 for 6-12 classes; β: 0.33, 95% CI: 0.13 to 0.52 for >12 years). Being divorced/widowed (β: -20.5, 95% CI: -35.7 to -5.3) or retired/disabled (β: -22.5, 95% CI: -41.6 to -3.3) showed a statistically significant association with reduced EQ-VAS scores. Having supplemental insurance was significantly linked to higher PCS scores (β: 2.4, 95% CI: 0.1 to 4.6), whereas current tobacco use was linked to lower MCS scores (β: -3.7, 95% CI: -7.4 to -0.02). A duration of dialysis ≥5 years was significantly associated with lower EQ-5D-5 L index scores (β: -0.17, 95% CI: -0.31 to -0.04). Comorbidities, age, and sex were not significantly associated with any of the HRQoL measures. HRQoL among HD patients in southern Iran was markedly reduced and influenced by socioeconomic, lifestyle, and treatment-related factors. Enhancing patient education, expanding insurance coverage, addressing gaps in social support, and incorporating lifestyle interventions-such as smoking cessation-may be associated with modest improvements in HRQoL outcomes in this population.