`4exploring Factors Affecting Health-related Quality of Life Among Hemodialysis Patients

`4exploring Factors Affecting Health-related Quality of Life Among Hemodialysis Patients | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article `4exploring Factors Affecting Health-related Quality of Life Among Hemodialysis Patients Priyadharsini M, Suseelal T, Helen Shaji J C This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7538130/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: End-stage renal disease (ESRD) requires hemodialysis, which significantly impacts multiple aspects of patient well-being. Understanding how demographic factors influence health-related quality of life (HRQOL) in this population is crucial for developing effective interventions. This study aims to assess the effect of demographic characteristics—age, sex, education, and occupation—on HRQOL in patients undergoing hemodialysis. Methods: A cross-sectional study was conducted among 44 adults receiving biweekly hemodialysis at a tertiary hospital in Tamil Nadu, India. Patients included were over 20 years old and had been on maintenance hemodialysis for at least six months. HRQOL was measured using the Kidney Disease Quality of Life (KDQOL) instrument, encompassing physical, mental, and disease-specific domains. Data collection involved structured interviews and observational checklists. Statistical analysis included descriptive statistics and the chi-square test to evaluate the association between demographic variables and HRQOL. Results: Among the participants, 79.5% were classified as having good quality of life and 20.5% as fair. Educational level and occupational status were significantly associated with HRQOL (p < 0.05). Patients aged above 50 years reported a higher burden of symptoms, while male participants achieved better physical health scores, and female participants achieved higher mental health scores. Most patients were unemployed and had only primary education. All patients fell into a low-income category and had comorbid diabetes and hypertension. No participants were classified as having poor quality of life. Conclusions: Demographic characteristics, particularly education and employment status, play a crucial role in shaping HRQOL for individuals on hemodialysis. Tailored interventions addressing educational and occupational barriers, alongside medical care, are essential to enhance patient quality of life and overall well-being. End-stage renal disease (ESRD) Hemodialysis Health-related quality of life (HRQOL) Demographic characteristics Kidney Disease Quality of Life (KDQOL) Patient outcomes Figures Figure 1 Figure 2 Figure 3 1. Background End-stage renal disease (ESRD) represents a major global health burden, resulting from the gradual decline in the function of the kidneys and requiring renal replacement therapy predominantly in the form of hemodialysis [ 1 – 3 ]. In the WHO’s recent report, there were nearly 2 million people in the world needing dialysis, in which the majority of these patients suffered a significant decrease in their health-related quality of life (HRQOL) [ 1 , 4 – 6 ]. The consequences of ESRD go beyond patients' physical health, involving their emotional, social, and economic dimensions [ 5 , 6 ]. Due to this multifaceted impact, it is important for us to have a better understanding of the determinants of ESRD patients’ HRQOL, especially in the light of the demographic characteristics that might influence health results. Studies have shown that hemodialysis patients encounter many problems which may influence their HRQOL negatively. These challenges stem from the burden of comorbidities such as diabetes and hypertension – commonly co-existing conditions in the ESRD patient – that adds to the complexity of their treatment regimen [ 7 ]. These comorbidities not only hamper clinical management but they also enhance the risk of CV events and death and further reduce the quality of life in these patients. In addition, socioeconomic status— such as income, educational level, and occupational status— have been found to have a notable effect on health status in this group [ 8 ]. It is important to have a knowledge of QoL problems of patients on hemodialysis to formulate specific interventions to improve their overall health status [ 9 ]. The Kidney Disease Quality of Life (KDQOL) instrument [ 10 ] is being used increasingly for the measurement of HRQOL among this group. The KDQOL contains both generic and disease-specific measures and is a multidimensional instrument for assessment of the physical, mental and emotional state of patients with kidney disease. With the use of such tool, researchers can learn more about the actual problems and difficulties of patients on regular dialysis cycles and subsequently develop appropriate support mechanisms as well as interventions [ 11 ]. In recent years, there has been a growing body of literature focusing on the factors influencing HRQOL among patients undergoing hemodialysis[ 12 ] [ 13 ]. These studies have highlighted the importance of addressing not only the medical needs of patients but also the social determinants of health that can significantly impact their quality of life. For instance, studies have shown that patients with higher educational levels tend to report better health outcomes, as they are often more informed about their conditions and treatment options. Additionally, the role of emotional and psychological support in managing chronic conditions has been emphasized, as mental health issues often remain unaddressed in patients with limited health literacy [ 14 , 15 ]. A cross-sectional study by Zyoud et al., investigated health-related quality of life (HRQOL) among 267 Palestinian hemodialysis patients using the EQ-5D-5L instrument. The mean EQ-5D-5L index value was 0.37 ± 0.44. Factors negatively associated with HRQOL included increasing age, higher numbers of chronic co-morbid diseases, and more chronic medications. Conversely, male gender, university education, and living in a village were positively associated with HRQOL. The findings highlight the need for healthcare providers to focus on improving HRQOL for vulnerable patient groups, such as the elderly, females, and those with multiple co-morbidities [ 16 ]. Nowrooz et al. investigated the quality of life (QOL) among 175 hemodialysis patients, finding a significant association between QOL and dialysis shift time. Patients on the night shift (Shift 4) exhibited the lowest overall QOL, particularly in health, psychological, spiritual, social, and economic domains. The findings suggest a need for enhanced support for night shift patients to improve their QOL [ 17 ]. Sulkowski et al. observed that hemodialysis patients experience diminished physical and psychological quality of life, particularly males. Social support, especially emotional and informational, is crucial for improving outcomes, with marital status playing a key role [ 18 ]. Another study found that health-related quality of life declines with advanced chronic kidney disease, particularly impacting kidney-specific domains. Socioeconomic factors like unemployment and illiteracy significantly affect patient quality of life [ 19 ]. Further, a study assessed the quality of life (QOL) in end-stage renal disease patients undergoing maintenance hemodialysis, finding it relatively compromised. The physical domain was most affected, while social relationships showed the best QOL scores. Age and education were significant independent variables, with increasing age leading to decreased QOL and higher education correlating with better QOL. Employment and marital status also influenced QOL domains [ 20 , 21 ]. 2. Methodology 2.1 Aim The present study aims to explore the factors affecting HRQOL among hemodialysis patients, with a specific focus on demographic variables such as age, sex, income, education, and occupation. By employing a cross-sectional research design and utilizing the KDQOL instrument, this study seeks to provide a comprehensive analysis of the quality of life among patients undergoing hemodialysis in the context of a specific healthcare setting. The findings of this research will contribute to the existing body of knowledge on HRQOL in ESRD patients and inform the development of targeted interventions that can enhance the overall well-being of this vulnerable population. 2.2 Study design and setting A cross-sectional research design was implemented to explore the factors affecting health-related quality of life among hemodialysis patients. The tools employed for the purpose of data acquisition were bifurcated into two distinct components. Component A encompassed demographic variables [ 22 ]. Component B entailed a meticulously structured interview schedule utilizing the KDQOL™-36 instrument [ 23 ]. The KDQOL™-36 comprises five subscales: the physical component summary (PCS), the mental component summary (MCS), the burden of kidney disease (BKD), the symptoms and problems of kidney disease (SPKD), and the effects of kidney disease (EKD). The initial two subscales serve as a general assessment of health-related quality of life (HRQOL) and are the same as those found in the SF-12. In contrast, the final three subscales focus on concerns particular to patients with end-stage renal disease (ESRD) or earlier stages of chronic kidney disease. This research was carried out in the waiting area of the Dialysis unit at SRM General Hospital and Research Institute, located in Chengalpattu District, Tamil Nadu. 2.3 Participants Forty-four patients over the age of 20 who have end-stage renal disease and have been on hemodialysis for at least 6 months in the Dialysis unit waiting area in the SRM General Hospital and Research Institute, Chengalpattu District Tamil Nadu, are chosen for the study by consecutive sampling method after obtaining appropriate consent. The results of the study were evaluated by directly interrogating with the participants and utilizing observational lists. The gathered information was organized for a comparative examination. 2.4 Variables The parameters for inclusion were: ESRD individuals who were aged 18 years and older of either gender; undergoing consistent biweekly hemodialysis for a duration of at least one year or longer; proficient in speaking/reading the vernacular or English and capable of providing informed consent to engage in the research. Individuals were excluded if they possessed malignancies, neoplasms, or multiple organ system failure, significant auditory impairment (inability to perceive loud speech even with assistive hearing devices), rejection episodes, or any substantial surgical procedures within the preceding three months. We selected individuals who had been on consistent hemodialysis for a minimum of six months prior to their enrollment in the study, as quality of life measurements are less likely to be affected by metabolic instability and the mode of dialysis treatment following three months of maintenance hemodialysis. 2.5 Statistical analysis, Assessment Tools and Scoring Methods for Evaluating Quality of Life in Dialysis Patients 2.5.1 Statistical analysis The collected data were analyzed using Statistical package for social sciences, version 25. A 36-item questionnaire was employed to gather data. The generic core was represented by items 1–12, the burden of kidney disease by items 13–16, the symptoms/problems by items 17–28, and the impact of kidney disease by items 29–36. The reliability of the instrument was assessed utilizing the test-retest methodology yielding coefficients of 0.70–0.86. Descriptive statistics were utilized to analyze frequency, percentage, mean, and standard deviation. Inferential statistics were employed to analyze the quality of life among individuals undergoing dialysis and various demographic variables. 2.5.2 Tool - Kidney Disease Quality of Life The KDQOL-SF 36 encompasses both general measures and measures specific to individuals with kidney disease [ 24 ]. The general measures were predicated on inquiries from the 36-item Short-Form Health Survey (SF-36), developed by Ware and Sherbourne [ 25 ]. Patient responses to the SF-36 inquiries were utilized to ascertain scores for the mental component summary (MCS) and the physical component summary (PCS). The scales for MCS and PCS are derived from eight distinct subscales: physical functioning role (physical, bodily pain, general health, and vitality) and social functioning role (emotional and mental health) [ 25 ]. 2.5.3 kidney disease component summary (KDCS) The kidney disease component summary (KDCS) score, which corresponds to the MCS and PCS of the SF-36, is derived from 11 subscales: symptoms/problems, effects of kidney disease on daily existence, burden of kidney disease, work status, cognitive function, quality of social interaction, sexual function, sleep, social support, dialysis staff encouragement, and patient satisfaction. On all scales, the potential scores range from 0 to 100; elevated scores denote enhanced functioning or superior quality of life [ 24 ]. 2.6 Ethics approval and consent to participate The study was reviewed and approved by Institutional Ethics Committee, SRM Institute of Science and Technology (REG.No: ECR/431/Inst/TN/2013/RR-24). All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the Helsinki declaration (2013 revision). Permission to conduct the study was obtained from Head of Department Nephrology SRMGH. Written Consent was obtained from all participants before participation. The authors affirm that there was no academic misconduct, including plagiarism, data fabrication, or duplicate publication. 3. Results 3.1 Frequency and percentage distribution of demographic variables of the patients undergoing hemodialysis The high prevalence of comorbid diabetes and hypertension among these dialysis patients highlights the critical need for integrated management strategies that address both conditions simultaneously. Research indicates that such co-morbidities significantly increase the risk of cardiovascular events and complications, thereby complicating the overall treatment landscape for patients undergoing renal replacement therapy [26]. Furthermore, the socioeconomic factors, including low income and educational attainment observed, may exacerbate health outcomes, as patients with lower socioeconomic status often experience higher mortality rates and poorer management of their chronic conditions [27]. This underscores the importance of developing targeted interventions that not only focus on medical treatment but also consider the broader social determinants of health, which can profoundly influence patient compliance and quality of life. Figures 1 and 2 show the proportions of patients by age group and the percentage of patients for each frequency of dialysis. Table 1. Frequency and percentage distribution of demographic variables of the patients undergoing hemodialysis (N=44) Demographic Variables Category No. % Age in years 20 – 30 3 6.8 31 – 40 4 9.1 41 – 50 10 22.7 >50 27 61.4 Sex Male 26 59.1 Female 18 40.9 Income 40000 - - Education No formal education - - Primary 27 61.4 Higher secondary 17 38.6 UG/PG - - Occupation Yes 17 38.6 No 27 61.4 Number of dialysis per week 1 7 15.9 2 37 84.1 3 - - Number of years on dialysis One to two 44 100.0 Two to three - - Three to four - - More than 4 years - - Comorbidities Diabetes Mellitus - - Hypertension 7 15.9 Both 37 84.1 Table 1 indicates that the majority of patients undergoing dialysis, specifically 27 individuals (61.4%), were over the age of 50. Additionally, 26 patients (59.1%) were male. All 44 patients (100%) reported an income ranging from 10,000 to 20,000. Furthermore, 27 patients (61.4%) had attained only primary education and were unemployed. A significant proportion, 37 patients (84.1%), underwent dialysis twice weekly. All patients (100%) had been on dialysis for a duration of one to two years, and 37 patients (84.1%) presented with both diabetes and hypertension as comorbid conditions. 3.2 Frequency, percentage distribution, assessment of mean and standard deviation of the level of quality of life of the patients undergoing hemodialysis Table 2 summarizes that out of 44 patients with end-stage renal disease who have been on hemodialysis, 35 had a good quality of life and 9 had a fair quality of life. This positive outcome highlights the importance of targeted interventions and support systems in enhancing the quality of life for patients undergoing hemodialysis. Factors such as emotional well-being, social support, and effective management of comorbid conditions play a crucial role in this context. Table 2. Frequency and percentage distribution of the level of quality of life of patients undergoing hemodialysis (N = 44) Level of Quality of Life F % Poor QoL - - Fair QoL 9 20.5 Good QoL 35 79.5 Table 3 depicts that the mean score of QoL was 105.50, with a minimum score of 80.0 and a maximum score of 149.0. Moreover, the implications of these findings extend beyond individual patient care, highlighting the necessity for healthcare systems to adopt a holistic approach in managing dialysis patients. For instance, integrating social support programs that address educational and employment barriers could significantly enhance patient engagement and adherence to treatment regimens. Studies have shown that patients with higher educational levels tend to report better health outcomes and quality of life, as they are often more informed about their conditions and treatment options. Additionally, the role of community resources in providing emotional and psychological support cannot be overlooked, especially in populations facing socioeconomic challenges. Implementing comprehensive care models that include multidisciplinary teams could not only improve clinical outcomes but also foster a supportive environment that encourages patients to take an active role in their health management. Table 3. Assessment of mean and standard deviation of quality of life of patients undergoing hemodialysis (N = 44) Quality of Life Score Minimum 80.0 Maximum 149.0 Median 105.50 Mean 108.79 S.D 15.19 3.3 KDQOL domain-wise score analysis with demographic variables. The relationship between educational attainment and health outcomes in dialysis patients warrants further examination, as it may significantly influence both physical and mental health perceptions. For instance, individuals with higher education levels often report better health-related quality of life, highlighting a potential correlation between knowledge and health management strategies. This is particularly relevant given that those with lower educational backgrounds frequently face greater barriers to accessing healthcare resources, which can exacerbate their symptom burden and overall quality of life [28]. Additionally, the emotional and psychological dimensions of living with chronic kidney disease can further compound these disparities, as mental health issues often remain unaddressed in patients with limited health literacy [29]. Understanding these dynamics is crucial for developing targeted interventions that improve health outcomes across diverse patient populations. Table 4 presents an analysis of the Kidney Disease Quality of Life (KDQOL) scores, highlighting the influence of various demographic factors on the physical health, mental well-being, symptom burden, and overall quality of life among dialysis patients. Patients over the age of 50 report a greater number of symptoms (33.37 ± 9.45), while those aged 20 to 30 experience fewer symptoms (28.33 ± 1.52). In terms of physical health, males show better scores (20.26 ± 2.89) compared to females (18.77 ± 3.97). However, females achieve higher mental health scores (17.16 ± 5.15) than their male counterparts (15.42 ± 3.98). Additionally, females report a greater burden of symptoms and problems (32.83 ± 9.42) compared to males (29.80 ± 7.26). Individuals with a primary education level report better physical health (20.51 ± 3.50) but lower mental health scores (15.92 ± 4.52). Table 4. KDQOL domain-wise score analysis with demographic variables (N = 44) Demographic Variables Physical Mental Burden Symptoms and problems Effects Overall 19.65±3.41 16.13±4.52 19.93±4.83 31.04±8.25 25.81±4.89 Age in years 20 – 30 15.33±2.88 15.66±4.61 19.33±2.30 28.33±1.52 26.00±6.00 31 – 40 17.75±2.62 16.75±4.78 18.25±4.92 28.25±4.03 27.25±5.05 41 – 50 19.40±2.45 16.60±5.08 19.90±3.87 26.70±4.21 26.00±4.42 >50 20.51±3.50 15.92±4.52 20.25±5.45 33.37±9.45 25.51±5.16 Sex Male 20.26±2.89 15.42±3.98 19.73±5.82 29.80±7.26 25.65±5.11 Female 18.77±3.97 17.16±5.15 20.22±3.04 32.83±9.42 26.05±4.68 Income 40000 - - - - - Education No formal education - - - - - Primary 20.51±3.50 15.92±4.52 20.25±5.45 33.37±9.45 25.51±5.16 Higher secondary 18.29±2.86 16.47±4.65 19.41±3.75 27.35±3.74 26.29±4.53 UG/PG - - - - - Occupation Yes 18.29±2.86 16.47±4.65 19.41±3.75 27.35±3.74 26.29±4.53 No 20.51±3.50 15.92±4.52 20.25±5.45 33.37±9.45 25.51±5.16 Number of dialysis per week 1 16.71±2.81 16.28±4.34 18.71±3.77 28.28±2.98 26.71±5.02 2 20.21±3.25 16.10±4.61 20.16±5.02 31.56±8.83 25.64±4.91 3 - - - - - Number of years on dialysis One to two 19.65±3.41 16.13±4.52 19.93±4.83 31.04±8.25 25.81±4.89 Two to three - - - - - Three to four - - - - - More than 4 years - - - - - Comorbidities Diabetes Mellitus - - - - - Hypertension 16.71±2.81 16.28±4.34 18.71±3.77 28.28±2.98 26.71±5.02 Both 20.21±3.25 16.10±4.61 20.16±5.02 31.56±8.83 25.64±4.91 3.4 Association of the level of quality of life among the patients undergoing hemodialysis with their selected demographic variables Table 5 illustrates that the demographic variables of education (c² = 7.124, p = 0.028) and occupation (c² = 7.124, p = 0.028) exhibit a statistically significant association with the quality-of-life levels of patients undergoing hemodialysis, at a significance level of p < 0.05. Conversely, the remaining demographic variables did not demonstrate a statistically significant association with the quality-of-life levels of these patients at the same significance threshold. Figure 3 shows a stacked column graph of the quality of life (%) of hemodialysis patients across different age and sex groups. Furthermore, these findings suggest that giving educational opportunities and employment for hemodialysis patients may improve their quality of life. For example, patients with high education qualification reported better health-related quality of life (HRQOL) and also demonstrated greater resilience in managing their health conditions, as found by a significant correlation between education level and quality of life scores in similar studies [30]. In addition, addressing occupational factors could lead to improved social support systems, which are crucial for patients undergoing long-term treatments like hemodialysis. Such interventions could ultimately reduce the burden of healthcare costs and improve the psychological well-being of patients, thereby fostering a more holistic approach to their care [31]. 4. Discussion The findings from the study demonstrate the significant challenges faced by dialysis patients, particularly those with comorbid conditions such as diabetes and hypertension. The high prevalence of these comorbidities not only complicates the management of renal replacement therapy but also escalates the risk of adverse cardiovascular events. This necessitates a shift towards integrated management strategies that simultaneously address multiple health conditions, thereby enhancing patient outcomes. The demographic profile of the patients reveals a concerning trend: a majority are over the age of 50, predominantly male, and have low educational attainment coupled with unemployment. These socioeconomic factors are crucial in understanding the overall health trajectory of these patients. The correlation between lower socioeconomic status and poorer health outcomes is well-documented, as individuals in these circumstances often face barriers to accessing quality healthcare and adhering to treatment regimens. This highlights the necessity for healthcare systems to adopt a holistic approach that encompasses not only medical treatment but also the social determinants of health. The reported quality of life (QoL) outcomes, with 35 out of 44 patients indicating a good quality of life, suggest that targeted interventions can yield positive results. Factors such as emotional well-being and social support emerged as critical components influencing QoL. This aligns with existing literature that emphasizes the importance of emotional and psychological support in managing chronic conditions. The mean QoL score of 105.50 indicates that while many patients experience a satisfactory quality of life, there remains a notable proportion who do not. This disparity calls for tailored interventions that address the unique needs of different patient segments, particularly those with lower educational backgrounds who may struggle with health literacy and access to resources. The analysis of the Kidney Disease Quality of Life (KDQOL) scores further illuminates the intricate relationship between demographic factors and health outcomes. The findings reveal that older patients report a higher symptom burden, while males exhibit better physical health scores compared to females, who, conversely, achieve higher mental health scores. This gender disparity highlights the multifaceted nature of health perceptions and outcomes in dialysis patients, indicating that interventions should be gender-sensitive to effectively address the unique needs of each group. The statistically significant associations between education and occupation with QoL levels emphasize the critical role of educational and employment opportunities in improving health outcomes. Patients with higher educational attainment not only report better health-related quality of life but also demonstrate greater resilience in managing their health. This reinforces the notion that enhancing educational programs and vocational training for dialysis patients could serve as a pivotal strategy for improving their overall well-being. Additionally, addressing occupational factors could foster stronger social support systems, which are essential for individuals undergoing long-term treatments. 5. Conclusion This research investigated the quality of life (QoL) among 44 individuals diagnosed with chronic kidney disease (CKD) undergoing hemodialysis. The Kidney Disease Quality of Life (KDQOL) instrument was employed to evaluate QoL across multiple domains, yielding insights into the patients' physical, mental, and disease-specific well-being. The findings indicated that the Mental Component Summary (MCS) recorded the lowest average score, with a mean of 16.13 ± 4.52, signifying poor mental health outcomes. In contrast, the Symptoms/Problems of Kidney Disease (SPKD) domain demonstrated a higher mean score of 31.04 ± 8.25, implying that participants experienced moderate levels of mental well-being. Age-related disparities were noted, with younger patients reporting significantly improved mental health-related QoL. However, age did not exert a considerable influence on either physical or disease-specific QoL scores. In terms of gender differences, male participants exhibited significantly superior physical health-related QoL compared to their female counterparts. Regarding the overall classification of QoL, the majority of patients (35 out of 44; 79.5%) reported a good quality of life, while 9 patients (20.5%) indicated a fair quality of life. Notably, none of the participants were classified as having a poor QoL. Additionally, the analysis revealed that educational attainment and employment status were significantly correlated with QoL scores. Patients with higher levels of education and those who were employed reported enhanced QoL outcomes, a relationship that was statistically significant as demonstrated by the chi-square test results (χ² = 7.124, p = 0.028). These findings emphasize the impact of demographic factors on QoL among patients undergoing hemodialysis, underscoring the necessity for targeted interventions aimed at improving mental well-being and supporting vulnerable populations, such as older adults and females, who may be at an elevated risk for adverse physical and mental health outcomes. The implications of this study are far-reaching, calling for a comprehensive approach that integrates clinical care with social support and education. By recognizing and addressing the socioeconomic barriers faced by dialysis patients, healthcare systems can significantly enhance patient engagement, adherence to treatment, and ultimately, health outcomes. Future research should continue to explore these dynamics, particularly the interplay between educational attainment, mental health, and chronic disease management, to inform targeted interventions that can improve the quality of life for diverse patient populations. Abbreviations ESRD: End-Stage Renal Disease HRQOL: Health-Related Quality of Life KDQOL: Kidney Disease Quality of Life KDQOL-SF: Kidney Disease Quality of Life Short Form SF-36: 36-item Short-Form Health Survey KDQOL™-36: 36-item Kidney Disease Quality of Life instrument PCS: Physical Component Summary MCS: Mental Component Summary BKD: Burden of Kidney Disease SPKD: Symptoms and Problems of Kidney Disease EKD: Effects of Kidney Disease QoL: Quality of Life CKD: Chronic Kidney Disease CV: Cardiovascular N.S: Not Significant S: Significant d.f: Degrees of Freedom χ²: Chi-Square F: Frequency SD/S.D: Standard Deviation Declarations Patient Consent for Publication Not applicable. Availability of data and materials Data will be made available upon request made to the corresponding author. Conflict of interests All authors confirm that they do not have any conflicts of interest to disclose. Funding This research did not receive any funding from any government or private institutions. Authors' contributions PM and ST were involved in the conceptualization of the study in discussion with HSJC. PM and ST contributed to data management and analysis for the study. PM drafted the manuscript. All authors have read and approved the final manuscript. Clinical trial number : not applicable. Authors' information (optional) Dr. Helen shaji J C - Orcid I'd :0000-0003-3006-2029 Priyadharsini. M - Orcid I'd :0009-0001-1693-6423 Dr. T. Suseelal - Orcid I’d: 0000-0002-0353-5023 References Thurlow JS, Joshi M, Yan G, Norris KC, Agodoa LY, Yuan CM, et al. Global Epidemiology of End-Stage Kidney Disease and Disparities in Kidney Replacement Therapy. Am J Nephrol. 2021;52:98. https://doi.org/10.1159/000514550 . El Hussein MT, Kilfoil L. Managing End-Stage Renal Disease: An Alphabetized Mnemonic Strategy. J Nurse Practitioners. 2019;15:732–6. https://doi.org/10.1016/J.NURPRA.2019.07.014 . McManus MS, Wynter-Minott S. 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Assessment of Quality of Life among End-Stage Renal Disease Patients Undergoing Maintenance Hemodialysis. Indian J Palliat Care. 2020;26:47–53. https://doi.org/10.4103/IJPC.IJPC_141_19 . Shi Y, Peng H, Chen Y, Deng J, Li W, He J, et al. Implementation of Cluster-Based Management Strategies for Patients With Chronic Kidney Disease. J Nurse Practitioners. 2020;16:689–94. https://doi.org/10.1016/J.NURPRA.2020.07.003 . Namimi-Halevi C, Keinan-Boker L, Dichtiar R, Beckerman P, Bromberg M. Pazit Beckerman ·. Travel Distance to Dialysis and Mortality Among Hemodialysis Patients in a Geographically Small Country n.d. https://doi.org/10.1007/s10900-025-01496-0 Kidney Disease and Quality of LifeTM (KDQOLTM-36). English Version 1, RAND and the University of Arizona 2000. Mollaoğlu M, Mollaoğlu M. Quality of Life in Patients Undergoing Hemodialysis. Hemodialysis. 2013. https://doi.org/10.5772/52277 Ware JEJ, Sherbourne CD. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care. 1992;30:473–83. Schutta MH. Diabetes and hypertension: epidemiology of the relationship and pathophysiology of factors associated with these comorbid conditions. J Cardiometab Syndr. 2007;2:124–30. https://doi.org/10.1111/J.1559-4564.2007.06368.X/FULL . Tao S, Zeng X, Liu J, Fu P. Socioeconomic status and mortality among dialysis patients: a systematic review and meta-analysis. Int Urol Nephrol. 2019;51:509–18. https://doi.org/10.1007/S11255-019-02078-5 . Fructuoso MR, Castro R, Oliveira I, Prata C, Morgado T. Quality of life in chronic kidney disease. Nefrologia. 2011;31:91–6. https://doi.org/10.3265/NEFROLOGIA.PRE2010.JUL.10483 . Kim J, Linos E, Rodriguez CI, Chen ML, Dove MS, Keegan TH. Prevalence and Associations of Poor Mental Health in the Third Year of COVID-19: U.S. Population-based Analysis from 2020 to 2022. Psychiatry Research-Neuroimaging 2023;330. https://doi.org/10.1016/J.PSYCHRES.2023.115622 Doan KVD, Nguyen HTM, Nguyen NTH, Dang KC, Yang SH, Van Duong T. Associations of Socio-Demographic, Clinical and Biochemical Parameters with Healthcare Cost, Health- and Renal-Related Quality of Life in Hemodialysis Patients: A Clinical Observational Study. Int J Environ Res Public Health. 2020;17:6552. https://doi.org/10.3390/IJERPH17186552 . Javanbakhtian Ghahfarokhi R, Abbaszadeh A. The relationship between quality of life and demographic variables in hemodialysis patients. J Jahrom Univ Med Sci. 2012;10:1–7. https://doi.org/10.29252/JMJ.10.3.1 . Table 5 Table 5 is available in the Supplementary Files section. Additional Declarations No competing interests reported. Supplementary Files DEMOGRAPHICVARIABLEQOL.docx kdqol36.pdf Table5.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7538130","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":519702344,"identity":"79f2538b-bfca-4c28-b09e-3cf9cc503bd3","order_by":0,"name":"Priyadharsini M","email":"","orcid":"","institution":"SRM College of Nursing , Faculty of Medical and Health Sciences, SRM Institute of Science and Technology","correspondingAuthor":false,"prefix":"","firstName":"Priyadharsini","middleName":"","lastName":"M","suffix":""},{"id":519702345,"identity":"917ed161-cdd2-4e22-9939-04693360908d","order_by":1,"name":"Suseelal T","email":"","orcid":"","institution":"SRM College of Nursing , Faculty of Medical and Health Sciences, SRM Institute of Science and Technology","correspondingAuthor":false,"prefix":"","firstName":"Suseelal","middleName":"","lastName":"T","suffix":""},{"id":519702346,"identity":"5fd23614-24f8-4eec-9583-62c0caf3e8fc","order_by":2,"name":"Helen Shaji J C","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA9UlEQVRIiWNgGAWjYBACAwbmBiB1gJkfxEtggJIJeLUwQrRINoAVGxCvhcHgAJSPXz0QmLM3Nj4u+HOH3fj82acbHvz5w8DPnmPA8HAHbi2WPQebjWe2PWM2u5FudiOxzYBBsueNAUPiGTwOAyqT5m04DNTCxnYjscEAKAK0JbENj5b7D9t/8/w5zGzcf4ztRsIfAwZ7glpuMLYx87AdZjZgSANqYQPaIkFIy5nEZmnetsPMEjeAWhLbjHkkzjwrOIBXy/HDBz8DHZbMD3TYzR9/5OT425M3PvyJRwsMJMMYPCDiAGENDAx2xCgaBaNgFIyCEQoA3wJVxJESvoIAAAAASUVORK5CYII=","orcid":"","institution":"SRM College of Nursing , Faculty of Medical and Health Sciences, SRM Institute of Science and 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01:07:27","extension":"xml","order_by":11,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":136277,"visible":true,"origin":"","legend":"","description":"","filename":"83f89fa48a194be191be7c7508bbdf8e1structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-7538130/v1/ca81cb0dd29ca1f89bbc5370.xml"},{"id":92682434,"identity":"c7ea680e-61e7-4e2b-96cf-6106923f9734","added_by":"auto","created_at":"2025-10-03 01:15:27","extension":"html","order_by":12,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":147998,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7538130/v1/70e33feaf12c16557a2c0836.html"},{"id":92680867,"identity":"7d88140b-10a6-4311-8936-611439999b42","added_by":"auto","created_at":"2025-10-03 01:07:27","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":40979,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eProportion of patients by age group\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7538130/v1/a9baffc654ea67230d6d4f1f.png"},{"id":92682429,"identity":"a1a22e68-140d-4b0f-bfad-8ff1788ce102","added_by":"auto","created_at":"2025-10-03 01:15:27","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":18957,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003e% of patients for each frequency of dialysis\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-7538130/v1/7acf5306c1de18b1e981be3d.png"},{"id":92682428,"identity":"fd8a714c-1fdf-41b9-921a-a57e10d86f21","added_by":"auto","created_at":"2025-10-03 01:15:27","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":29677,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eQuality of life (%) of hemodialysis patients across different age and sex groups\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-7538130/v1/da6e95ef4a5db73736bdfbb4.png"},{"id":104397703,"identity":"67593668-9aaf-4205-ab68-2cb0065e9ed0","added_by":"auto","created_at":"2026-03-11 11:54:48","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1501593,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7538130/v1/b5d6d80b-c693-4cad-95cc-7c3941601b8e.pdf"},{"id":92682840,"identity":"b4b539fb-5b99-45a9-a40f-e05880cb8267","added_by":"auto","created_at":"2025-10-03 01:23:27","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":23324,"visible":true,"origin":"","legend":"","description":"","filename":"DEMOGRAPHICVARIABLEQOL.docx","url":"https://assets-eu.researchsquare.com/files/rs-7538130/v1/2a1f2b1989af125edc0e452a.docx"},{"id":92680869,"identity":"ae13da02-83dd-4284-9f72-cbeb23cb8201","added_by":"auto","created_at":"2025-10-03 01:07:27","extension":"pdf","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":28181,"visible":true,"origin":"","legend":"","description":"","filename":"kdqol36.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7538130/v1/9d7276f24e28a4ec9667decc.pdf"},{"id":92680879,"identity":"80d9c052-f67c-4e59-a042-df5b0eca4119","added_by":"auto","created_at":"2025-10-03 01:07:27","extension":"docx","order_by":3,"title":"","display":"","copyAsset":false,"role":"supplement","size":20137,"visible":true,"origin":"","legend":"","description":"","filename":"Table5.docx","url":"https://assets-eu.researchsquare.com/files/rs-7538130/v1/c740cc3ba8cbb9fee17bd4b1.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003e`4exploring Factors Affecting Health-related Quality of Life Among Hemodialysis Patients\u003c/p\u003e","fulltext":[{"header":"1. Background","content":"\u003cp\u003eEnd-stage renal disease (ESRD) represents a major global health burden, resulting from the gradual decline in the function of the kidneys and requiring renal replacement therapy predominantly in the form of hemodialysis [\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. In the WHO\u0026rsquo;s recent report, there were nearly 2\u0026nbsp;million people in the world needing dialysis, in which the majority of these patients suffered a significant decrease in their health-related quality of life (HRQOL) [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan additionalcitationids=\"CR5\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. The consequences of ESRD go beyond patients' physical health, involving their emotional, social, and economic dimensions [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Due to this multifaceted impact, it is important for us to have a better understanding of the determinants of ESRD patients\u0026rsquo; HRQOL, especially in the light of the demographic characteristics that might influence health results.\u003c/p\u003e\u003cp\u003eStudies have shown that hemodialysis patients encounter many problems which may influence their HRQOL negatively. These challenges stem from the burden of comorbidities such as diabetes and hypertension \u0026ndash; commonly co-existing conditions in the ESRD patient \u0026ndash; that adds to the complexity of their treatment regimen [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. These comorbidities not only hamper clinical management but they also enhance the risk of CV events and death and further reduce the quality of life in these patients. In addition, socioeconomic status\u0026mdash; such as income, educational level, and occupational status\u0026mdash; have been found to have a notable effect on health status in this group [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIt is important to have a knowledge of QoL problems of patients on hemodialysis to formulate specific interventions to improve their overall health status [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. The Kidney Disease Quality of Life (KDQOL) instrument [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e] is being used increasingly for the measurement of HRQOL among this group. The KDQOL contains both generic and disease-specific measures and is a multidimensional instrument for assessment of the physical, mental and emotional state of patients with kidney disease. With the use of such tool, researchers can learn more about the actual problems and difficulties of patients on regular dialysis cycles and subsequently develop appropriate support mechanisms as well as interventions [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIn recent years, there has been a growing body of literature focusing on the factors influencing HRQOL among patients undergoing hemodialysis[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e] [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. These studies have highlighted the importance of addressing not only the medical needs of patients but also the social determinants of health that can significantly impact their quality of life. For instance, studies have shown that patients with higher educational levels tend to report better health outcomes, as they are often more informed about their conditions and treatment options. Additionally, the role of emotional and psychological support in managing chronic conditions has been emphasized, as mental health issues often remain unaddressed in patients with limited health literacy [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eA cross-sectional study by Zyoud et al., investigated health-related quality of life (HRQOL) among 267 Palestinian hemodialysis patients using the EQ-5D-5L instrument. The mean EQ-5D-5L index value was 0.37\u0026thinsp;\u0026plusmn;\u0026thinsp;0.44. Factors negatively associated with HRQOL included increasing age, higher numbers of chronic co-morbid diseases, and more chronic medications. Conversely, male gender, university education, and living in a village were positively associated with HRQOL. The findings highlight the need for healthcare providers to focus on improving HRQOL for vulnerable patient groups, such as the elderly, females, and those with multiple co-morbidities [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Nowrooz et al. investigated the quality of life (QOL) among 175 hemodialysis patients, finding a significant association between QOL and dialysis shift time. Patients on the night shift (Shift 4) exhibited the lowest overall QOL, particularly in health, psychological, spiritual, social, and economic domains. The findings suggest a need for enhanced support for night shift patients to improve their QOL [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eSulkowski et al. observed that hemodialysis patients experience diminished physical and psychological quality of life, particularly males. Social support, especially emotional and informational, is crucial for improving outcomes, with marital status playing a key role [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Another study found that health-related quality of life declines with advanced chronic kidney disease, particularly impacting kidney-specific domains. Socioeconomic factors like unemployment and illiteracy significantly affect patient quality of life [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Further, a study assessed the quality of life (QOL) in end-stage renal disease patients undergoing maintenance hemodialysis, finding it relatively compromised. The physical domain was most affected, while social relationships showed the best QOL scores. Age and education were significant independent variables, with increasing age leading to decreased QOL and higher education correlating with better QOL. Employment and marital status also influenced QOL domains [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e"},{"header":"2. Methodology","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003e2.1 Aim\u003c/h2\u003e\u003cp\u003eThe present study aims to explore the factors affecting HRQOL among hemodialysis patients, with a specific focus on demographic variables such as age, sex, income, education, and occupation. By employing a cross-sectional research design and utilizing the KDQOL instrument, this study seeks to provide a comprehensive analysis of the quality of life among patients undergoing hemodialysis in the context of a specific healthcare setting. The findings of this research will contribute to the existing body of knowledge on HRQOL in ESRD patients and inform the development of targeted interventions that can enhance the overall well-being of this vulnerable population.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\u003ch2\u003e2.2 Study design and setting\u003c/h2\u003e\u003cp\u003eA cross-sectional research design was implemented to explore the factors affecting health-related quality of life among hemodialysis patients. The tools employed for the purpose of data acquisition were bifurcated into two distinct components. Component A encompassed demographic variables [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Component B entailed a meticulously structured interview schedule utilizing the KDQOL\u0026trade;-36 instrument [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. The KDQOL\u0026trade;-36 comprises five subscales: the physical component summary (PCS), the mental component summary (MCS), the burden of kidney disease (BKD), the symptoms and problems of kidney disease (SPKD), and the effects of kidney disease (EKD).\u003c/p\u003e\u003cp\u003eThe initial two subscales serve as a general assessment of health-related quality of life (HRQOL) and are the same as those found in the SF-12. In contrast, the final three subscales focus on concerns particular to patients with end-stage renal disease (ESRD) or earlier stages of chronic kidney disease. This research was carried out in the waiting area of the Dialysis unit at SRM General Hospital and Research Institute, located in Chengalpattu District, Tamil Nadu.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\u003ch2\u003e2.3 Participants\u003c/h2\u003e\u003cp\u003eForty-four patients over the age of 20 who have end-stage renal disease and have been on hemodialysis for at least 6 months in the Dialysis unit waiting area in the SRM General Hospital and Research Institute, Chengalpattu District Tamil Nadu, are chosen for the study by consecutive sampling method after obtaining appropriate consent. The results of the study were evaluated by directly interrogating with the participants and utilizing observational lists. The gathered information was organized for a comparative examination.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\u003ch2\u003e2.4 Variables\u003c/h2\u003e\u003cp\u003eThe parameters for inclusion were: ESRD individuals who were aged 18 years and older of either gender; undergoing consistent biweekly hemodialysis for a duration of at least one year or longer; proficient in speaking/reading the vernacular or English and capable of providing informed consent to engage in the research. Individuals were excluded if they possessed malignancies, neoplasms, or multiple organ system failure, significant auditory impairment (inability to perceive loud speech even with assistive hearing devices), rejection episodes, or any substantial surgical procedures within the preceding three months. We selected individuals who had been on consistent hemodialysis for a minimum of six months prior to their enrollment in the study, as quality of life measurements are less likely to be affected by metabolic instability and the mode of dialysis treatment following three months of maintenance hemodialysis.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\u003ch2\u003e2.5 Statistical analysis, Assessment Tools and Scoring Methods for Evaluating Quality of Life in Dialysis Patients\u003c/h2\u003e\u003cdiv id=\"Sec8\" class=\"Section3\"\u003e\u003ch2\u003e2.5.1 Statistical analysis\u003c/h2\u003e\u003cp\u003eThe collected data were analyzed using Statistical package for social sciences, version 25. A 36-item questionnaire was employed to gather data. The generic core was represented by items 1\u0026ndash;12, the burden of kidney disease by items 13\u0026ndash;16, the symptoms/problems by items 17\u0026ndash;28, and the impact of kidney disease by items 29\u0026ndash;36. The reliability of the instrument was assessed utilizing the test-retest methodology yielding coefficients of 0.70\u0026ndash;0.86. Descriptive statistics were utilized to analyze frequency, percentage, mean, and standard deviation. Inferential statistics were employed to analyze the quality of life among individuals undergoing dialysis and various demographic variables.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec9\" class=\"Section3\"\u003e\u003ch2\u003e2.5.2 Tool - Kidney Disease Quality of Life\u003c/h2\u003e\u003cp\u003eThe KDQOL-SF 36 encompasses both general measures and measures specific to individuals with kidney disease [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. The general measures were predicated on inquiries from the 36-item Short-Form Health Survey (SF-36), developed by Ware and Sherbourne [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Patient responses to the SF-36 inquiries were utilized to ascertain scores for the mental component summary (MCS) and the physical component summary (PCS). The scales for MCS and PCS are derived from eight distinct subscales: physical functioning role (physical, bodily pain, general health, and vitality) and social functioning role (emotional and mental health) [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e].\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec10\" class=\"Section3\"\u003e\u003ch2\u003e2.5.3 kidney disease component summary (KDCS)\u003c/h2\u003e\u003cp\u003eThe kidney disease component summary (KDCS) score, which corresponds to the MCS and PCS of the SF-36, is derived from 11 subscales: symptoms/problems, effects of kidney disease on daily existence, burden of kidney disease, work status, cognitive function, quality of social interaction, sexual function, sleep, social support, dialysis staff encouragement, and patient satisfaction. On all scales, the potential scores range from 0 to 100; elevated scores denote enhanced functioning or superior quality of life [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e].\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\n\u003ch2\u003e2.6 Ethics approval and consent to participate\u003c/h2\u003e\n\u003cp\u003eThe study was reviewed and approved by Institutional Ethics Committee, SRM Institute of Science and Technology (REG.No: ECR/431/Inst/TN/2013/RR-24). All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the Helsinki declaration (2013 revision). Permission to conduct the study was obtained from Head of Department Nephrology SRMGH. Written Consent was obtained from all participants before participation. The authors affirm that there was no academic misconduct, including plagiarism, data fabrication, or duplicate publication.\u003c/p\u003e"},{"header":"3. Results","content":"\u003ch2\u003e3.1 Frequency and percentage distribution of demographic variables of the patients undergoing hemodialysis\u003c/h2\u003e\n\u003cp\u003eThe high prevalence of comorbid diabetes and hypertension among these dialysis patients highlights the critical need for integrated management strategies that address both conditions simultaneously. Research indicates that such co-morbidities significantly increase the risk of cardiovascular events and complications, thereby complicating the overall treatment landscape for patients undergoing renal replacement therapy [26]. Furthermore, the socioeconomic factors, including low income and educational attainment observed, may exacerbate health outcomes, as patients with lower socioeconomic status often experience higher mortality rates and poorer management of their chronic conditions [27]. This underscores the importance of developing targeted interventions that not only focus on medical treatment but also consider the broader social determinants of health, which can profoundly influence patient compliance and quality of life. Figures 1 and 2 show the proportions of patients by age group and the percentage of patients for each frequency of dialysis.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1. Frequency and percentage distribution of demographic variables of the patients undergoing hemodialysis (N=44)\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"72%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDemographic Variables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCategory\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo.\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 34px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge in years\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 20px;\"\u003e\n \u003cp\u003e20 \u0026ndash; 30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003e6.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 34px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 20px;\"\u003e\n \u003cp\u003e31 \u0026ndash; 40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003e9.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 34px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 20px;\"\u003e\n \u003cp\u003e41 \u0026ndash; 50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003e22.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 34px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 20px;\"\u003e\n \u003cp\u003e\u0026gt;50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003e61.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 34px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSex\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 20px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003e59.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 34px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 20px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003e40.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 34px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIncome\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 20px;\"\u003e\n \u003cp\u003e\u0026lt;10000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 34px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 20px;\"\u003e\n \u003cp\u003e10000 \u0026ndash; 20000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003e100.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 34px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 20px;\"\u003e\n \u003cp\u003e20000 \u0026ndash; 30000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 34px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 20px;\"\u003e\n \u003cp\u003e\u0026gt;40000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 34px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEducation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 20px;\"\u003e\n \u003cp\u003eNo formal education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 34px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 20px;\"\u003e\n \u003cp\u003ePrimary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003e61.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 34px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 20px;\"\u003e\n \u003cp\u003eHigher secondary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003e38.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 34px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 20px;\"\u003e\n \u003cp\u003eUG/PG\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 34px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOccupation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 20px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003e38.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 34px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 20px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003e61.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 34px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNumber of dialysis per week\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 20px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003e15.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 34px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 20px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003e84.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 34px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 20px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 34px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNumber of years on dialysis\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 20px;\"\u003e\n \u003cp\u003eOne to two\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003e100.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 34px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 20px;\"\u003e\n \u003cp\u003eTwo to three\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 34px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 20px;\"\u003e\n \u003cp\u003eThree to four\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 34px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003eMore than 4 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 34px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eComorbidities\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 20px;\"\u003e\n \u003cp\u003eDiabetes Mellitus\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 34px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 20px;\"\u003e\n \u003cp\u003eHypertension\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003e15.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 34px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 20px;\"\u003e\n \u003cp\u003eBoth\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003e84.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003eTable 1 indicates that the majority of patients undergoing dialysis, specifically 27 individuals (61.4%), were over the age of 50. Additionally, 26 patients (59.1%) were male. All 44 patients (100%) reported an income ranging from 10,000 to 20,000. Furthermore, 27 patients (61.4%) had attained only primary education and were unemployed. A significant proportion, 37 patients (84.1%), underwent dialysis twice weekly. All patients (100%) had been on dialysis for a duration of one to two years, and 37 patients (84.1%) presented with both diabetes and hypertension as comorbid conditions.\u0026nbsp;\u003c/p\u003e\n\u003ch2\u003e3.2 Frequency, percentage distribution, assessment of mean and standard deviation of the level of quality of life of the patients undergoing hemodialysis\u003c/h2\u003e\n\u003cp\u003eTable 2 summarizes that out of 44 patients with end-stage renal disease who have been on hemodialysis, 35 had a good quality of life and 9 had a fair quality of life. This positive outcome highlights the importance of targeted interventions and support systems in enhancing the quality of life for patients undergoing hemodialysis. Factors such as emotional well-being, social support, and effective management of comorbid conditions play a crucial role in this context. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2. Frequency and percentage distribution of the level of quality of life of patients undergoing hemodialysis (N = 44)\u003c/strong\u003e\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"55%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLevel of Quality of Life\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eF\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003ePoor QoL\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e-\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e-\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003eFair QoL\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003e20.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003eGood QoL\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003e79.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 3 depicts that the mean score of QoL was 105.50, with a minimum score of 80.0 and a maximum score of 149.0. Moreover, the implications of these findings extend beyond individual patient care, highlighting the necessity for healthcare systems to adopt a holistic approach in managing dialysis patients. For instance, integrating social support programs that address educational and employment barriers could significantly enhance patient engagement and adherence to treatment regimens. Studies have shown that patients with higher educational levels tend to report better health outcomes and quality of life, as they are often more informed about their conditions and treatment options. Additionally, the role of community resources in providing emotional and psychological support cannot be overlooked, especially in populations facing socioeconomic challenges. Implementing comprehensive care models that include multidisciplinary teams could not only improve clinical outcomes but also foster a supportive environment that encourages patients to take an active role in their health management.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3. Assessment of mean and standard deviation of quality of life of patients undergoing hemodialysis (N = 44)\u003c/strong\u003e\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"46%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eQuality of Life\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eScore\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003eMinimum\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e80.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003eMaximum\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e149.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003eMedian\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e105.50\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003eMean\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e108.79\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003eS.D\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e15.19\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003ch2\u003e3.3 KDQOL domain-wise score analysis with demographic variables.\u0026nbsp;\u003c/h2\u003e\n\u003cp\u003eThe relationship between educational attainment and health outcomes in dialysis patients warrants further examination, as it may significantly influence both physical and mental health perceptions. For instance, individuals with higher education levels often report better health-related quality of life, highlighting a potential correlation between knowledge and health management strategies. This is particularly relevant given that those with lower educational backgrounds frequently face greater barriers to accessing healthcare resources, which can exacerbate their symptom burden and overall quality of life [28]. Additionally, the emotional and psychological dimensions of living with chronic kidney disease can further compound these disparities, as mental health issues often remain unaddressed in patients with limited health literacy [29]. Understanding these dynamics is crucial for developing targeted interventions that improve health outcomes across diverse patient populations.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 4 presents an analysis of the Kidney Disease Quality of Life (KDQOL) scores, highlighting the influence of various demographic factors on the physical health, mental well-being, symptom burden, and overall quality of life among dialysis patients. Patients over the age of 50 report a greater number of symptoms (33.37 \u0026plusmn; 9.45), while those aged 20 to 30 experience fewer symptoms (28.33 \u0026plusmn; 1.52). In terms of physical health, males show better scores (20.26 \u0026plusmn; 2.89) compared to females (18.77 \u0026plusmn; 3.97). However, females achieve higher mental health scores (17.16 \u0026plusmn; 5.15) than their male counterparts (15.42 \u0026plusmn; 3.98). Additionally, females report a greater burden of symptoms and problems (32.83 \u0026plusmn; 9.42) compared to males (29.80 \u0026plusmn; 7.26). Individuals with a primary education level report better physical health (20.51 \u0026plusmn; 3.50) but lower mental health scores (15.92 \u0026plusmn; 4.52).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4. KDQOL domain-wise score analysis with demographic variables\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e(N = 44)\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"115%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDemographic Variables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePhysical\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMental\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBurden\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSymptoms and problems\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEffects\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 13px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOverall\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e19.65\u0026plusmn;3.41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e16.13\u0026plusmn;4.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e19.93\u0026plusmn;4.83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e31.04\u0026plusmn;8.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e25.81\u0026plusmn;4.89\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 13px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge in years\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\n \u003cp\u003e20 \u0026ndash; 30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e15.33\u0026plusmn;2.88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e15.66\u0026plusmn;4.61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e19.33\u0026plusmn;2.30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e28.33\u0026plusmn;1.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e26.00\u0026plusmn;6.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 13px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\n \u003cp\u003e31 \u0026ndash; 40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e17.75\u0026plusmn;2.62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e16.75\u0026plusmn;4.78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e18.25\u0026plusmn;4.92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e28.25\u0026plusmn;4.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e27.25\u0026plusmn;5.05\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 13px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\n \u003cp\u003e41 \u0026ndash; 50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e19.40\u0026plusmn;2.45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e16.60\u0026plusmn;5.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e19.90\u0026plusmn;3.87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e26.70\u0026plusmn;4.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e26.00\u0026plusmn;4.42\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 13px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u0026gt;50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e20.51\u0026plusmn;3.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e15.92\u0026plusmn;4.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e20.25\u0026plusmn;5.45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e33.37\u0026plusmn;9.45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e25.51\u0026plusmn;5.16\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 13px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSex\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e20.26\u0026plusmn;2.89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e15.42\u0026plusmn;3.98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e19.73\u0026plusmn;5.82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e29.80\u0026plusmn;7.26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e25.65\u0026plusmn;5.11\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 13px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e18.77\u0026plusmn;3.97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e17.16\u0026plusmn;5.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e20.22\u0026plusmn;3.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e32.83\u0026plusmn;9.42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e26.05\u0026plusmn;4.68\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 13px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIncome\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u0026lt;10000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 13px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\n \u003cp\u003e10000 \u0026ndash; 20000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e19.65\u0026plusmn;3.41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e16.13\u0026plusmn;4.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e19.93\u0026plusmn;4.83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e31.04\u0026plusmn;8.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e25.81\u0026plusmn;4.89\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 13px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\n \u003cp\u003e20000 \u0026ndash; 30000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 13px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u0026gt;40000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 13px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEducation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\n \u003cp\u003eNo formal education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 13px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\n \u003cp\u003ePrimary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e20.51\u0026plusmn;3.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e15.92\u0026plusmn;4.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e20.25\u0026plusmn;5.45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e33.37\u0026plusmn;9.45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e25.51\u0026plusmn;5.16\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 13px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\n \u003cp\u003eHigher secondary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e18.29\u0026plusmn;2.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e16.47\u0026plusmn;4.65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e19.41\u0026plusmn;3.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e27.35\u0026plusmn;3.74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e26.29\u0026plusmn;4.53\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 13px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\n \u003cp\u003eUG/PG\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 13px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOccupation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e18.29\u0026plusmn;2.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e16.47\u0026plusmn;4.65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e19.41\u0026plusmn;3.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e27.35\u0026plusmn;3.74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e26.29\u0026plusmn;4.53\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 13px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e20.51\u0026plusmn;3.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e15.92\u0026plusmn;4.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e20.25\u0026plusmn;5.45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e33.37\u0026plusmn;9.45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e25.51\u0026plusmn;5.16\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 13px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNumber of dialysis per week\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e16.71\u0026plusmn;2.81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e16.28\u0026plusmn;4.34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e18.71\u0026plusmn;3.77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e28.28\u0026plusmn;2.98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e26.71\u0026plusmn;5.02\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 13px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e20.21\u0026plusmn;3.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e16.10\u0026plusmn;4.61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e20.16\u0026plusmn;5.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e31.56\u0026plusmn;8.83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e25.64\u0026plusmn;4.91\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 13px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 13px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNumber of years on dialysis\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 13px;\"\u003e\n \u003cp\u003eOne to two\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e19.65\u0026plusmn;3.41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e16.13\u0026plusmn;4.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e19.93\u0026plusmn;4.83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e31.04\u0026plusmn;8.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e25.81\u0026plusmn;4.89\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 13px;\"\u003e\n \u003cp\u003eTwo to three\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 13px;\"\u003e\n \u003cp\u003eThree to four\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003eMore than 4 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 13px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eComorbidities\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 13px;\"\u003e\n \u003cp\u003eDiabetes Mellitus\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 13px;\"\u003e\n \u003cp\u003eHypertension\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e16.71\u0026plusmn;2.81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e16.28\u0026plusmn;4.34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e18.71\u0026plusmn;3.77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e28.28\u0026plusmn;2.98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e26.71\u0026plusmn;5.02\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 13px;\"\u003e\n \u003cp\u003eBoth\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e20.21\u0026plusmn;3.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e16.10\u0026plusmn;4.61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e20.16\u0026plusmn;5.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e31.56\u0026plusmn;8.83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e25.64\u0026plusmn;4.91\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003ch2\u003e3.4 Association of the level of quality of life among the patients undergoing hemodialysis with their selected demographic variables\u003c/h2\u003e\n\u003cp\u003eTable 5 illustrates that the demographic variables of education (c\u0026sup2; = 7.124, p = 0.028) and occupation (c\u0026sup2; = 7.124, p = 0.028) exhibit a statistically significant association with the quality-of-life levels of patients undergoing hemodialysis, at a significance level of p \u0026lt; 0.05. Conversely, the remaining demographic variables did not demonstrate a statistically significant association with the quality-of-life levels of these patients at the same significance threshold.\u003c/p\u003e\n\u003cp\u003eFigure 3 shows a stacked column graph of the quality of life (%) of hemodialysis patients across different age and sex groups. Furthermore, these findings suggest that giving educational opportunities and employment for hemodialysis patients may improve their quality of life. For example, patients with high education qualification reported better health-related quality of life (HRQOL) and also demonstrated greater resilience in managing their health conditions, as found by a significant correlation between education level and quality of life scores in similar studies [30]. In addition, addressing occupational factors could lead to improved social support systems, which are crucial for patients undergoing long-term treatments like hemodialysis. Such interventions could ultimately reduce the burden of healthcare costs and improve the psychological well-being of patients, thereby fostering a more holistic approach to their care [31].\u003c/p\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eThe findings from the study demonstrate the significant challenges faced by dialysis patients, particularly those with comorbid conditions such as diabetes and hypertension. The high prevalence of these comorbidities not only complicates the management of renal replacement therapy but also escalates the risk of adverse cardiovascular events. This necessitates a shift towards integrated management strategies that simultaneously address multiple health conditions, thereby enhancing patient outcomes.\u003c/p\u003e\n\u003cp\u003eThe demographic profile of the patients reveals a concerning trend: a majority are over the age of 50, predominantly male, and have low educational attainment coupled with unemployment. These socioeconomic factors are crucial in understanding the overall health trajectory of these patients. The correlation between lower socioeconomic status and poorer health outcomes is well-documented, as individuals in these circumstances often face barriers to accessing quality healthcare and adhering to treatment regimens. This highlights the necessity for healthcare systems to adopt a holistic approach that encompasses not only medical treatment but also the social determinants of health.\u003c/p\u003e\n\u003cp\u003eThe reported quality of life (QoL) outcomes, with 35 out of 44 patients indicating a good quality of life, suggest that targeted interventions can yield positive results. Factors such as emotional well-being and social support emerged as critical components influencing QoL. This aligns with existing literature that emphasizes the importance of emotional and psychological support in managing chronic conditions. The mean QoL score of 105.50 indicates that while many patients experience a satisfactory quality of life, there remains a notable proportion who do not. This disparity calls for tailored interventions that address the unique needs of different patient segments, particularly those with lower educational backgrounds who may struggle with health literacy and access to resources.\u003c/p\u003e\n\u003cp\u003eThe analysis of the Kidney Disease Quality of Life (KDQOL) scores further illuminates the intricate relationship between demographic factors and health outcomes. The findings reveal that older patients report a higher symptom burden, while males exhibit better physical health scores compared to females, who, conversely, achieve higher mental health scores. This gender disparity highlights the multifaceted nature of health perceptions and outcomes in dialysis patients, indicating that interventions should be gender-sensitive to effectively address the unique needs of each group.\u003c/p\u003e\n\u003cp\u003eThe statistically significant associations between education and occupation with QoL levels emphasize the critical role of educational and employment opportunities in improving health outcomes. Patients with higher educational attainment not only report better health-related quality of life but also demonstrate greater resilience in managing their health. This reinforces the notion that enhancing educational programs and vocational training for dialysis patients could serve as a pivotal strategy for improving their overall well-being. Additionally, addressing occupational factors could foster stronger social support systems, which are essential for individuals undergoing long-term treatments.\u003c/p\u003e"},{"header":"5. Conclusion","content":"\u003cp\u003eThis research investigated the quality of life (QoL) among 44 individuals diagnosed with chronic kidney disease (CKD) undergoing hemodialysis. The Kidney Disease Quality of Life (KDQOL) instrument was employed to evaluate QoL across multiple domains, yielding insights into the patients\u0026apos; physical, mental, and disease-specific well-being. The findings indicated that the Mental Component Summary (MCS) recorded the lowest average score, with a mean of 16.13 \u0026plusmn; 4.52, signifying poor mental health outcomes. In contrast, the Symptoms/Problems of Kidney Disease (SPKD) domain demonstrated a higher mean score of 31.04 \u0026plusmn; 8.25, implying that participants experienced moderate levels of mental well-being. Age-related disparities were noted, with younger patients reporting significantly improved mental health-related QoL. However, age did not exert a considerable influence on either physical or disease-specific QoL scores. In terms of gender differences, male participants exhibited significantly superior physical health-related QoL compared to their female counterparts. Regarding the overall classification of QoL, the majority of patients (35 out of 44; 79.5%) reported a good quality of life, while 9 patients (20.5%) indicated a fair quality of life. Notably, none of the participants were classified as having a poor QoL. Additionally, the analysis revealed that educational attainment and employment status were significantly correlated with QoL scores. Patients with higher levels of education and those who were employed reported enhanced QoL outcomes, a relationship that was statistically significant as demonstrated by the chi-square test results (\u0026chi;\u0026sup2; = 7.124, p = 0.028). These findings emphasize the impact of demographic factors on QoL among patients undergoing hemodialysis, underscoring the necessity for targeted interventions aimed at improving mental well-being and supporting vulnerable populations, such as older adults and females, who may be at an elevated risk for adverse physical and mental health outcomes. The implications of this study are far-reaching, calling for a comprehensive approach that integrates clinical care with social support and education. By recognizing and addressing the socioeconomic barriers faced by dialysis patients, healthcare systems can significantly enhance patient engagement, adherence to treatment, and ultimately, health outcomes. Future research should continue to explore these dynamics, particularly the interplay between educational attainment, mental health, and chronic disease management, to inform targeted interventions that can improve the quality of life for diverse patient populations.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cul type=\"disc\"\u003e\n \u003cli\u003eESRD: End-Stage Renal Disease\u003c/li\u003e\n \u003cli\u003eHRQOL: Health-Related Quality of Life\u003c/li\u003e\n \u003cli\u003eKDQOL: Kidney Disease Quality of Life\u003c/li\u003e\n \u003cli\u003eKDQOL-SF: Kidney Disease Quality of Life Short Form\u003c/li\u003e\n \u003cli\u003eSF-36: 36-item Short-Form Health Survey\u003c/li\u003e\n \u003cli\u003eKDQOL\u0026trade;-36: 36-item Kidney Disease Quality of Life instrument\u003c/li\u003e\n \u003cli\u003ePCS: Physical Component Summary\u003c/li\u003e\n \u003cli\u003eMCS: Mental Component Summary\u003c/li\u003e\n \u003cli\u003eBKD: Burden of Kidney Disease\u003c/li\u003e\n \u003cli\u003eSPKD: Symptoms and Problems of Kidney Disease\u003c/li\u003e\n \u003cli\u003eEKD: Effects of Kidney Disease\u003c/li\u003e\n \u003cli\u003eQoL: Quality of Life\u003c/li\u003e\n \u003cli\u003eCKD: Chronic Kidney Disease\u003c/li\u003e\n \u003cli\u003eCV: Cardiovascular\u003c/li\u003e\n \u003cli\u003eN.S: Not Significant\u003c/li\u003e\n \u003cli\u003eS: Significant\u003c/li\u003e\n \u003cli\u003ed.f: Degrees of Freedom\u003c/li\u003e\n \u003cli\u003e\u0026chi;\u0026sup2;: Chi-Square\u003c/li\u003e\n \u003cli\u003eF: Frequency\u003c/li\u003e\n \u003cli\u003eSD/S.D: Standard Deviation\u003c/li\u003e\n\u003c/ul\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003ePatient Consent for Publication\u003c/strong\u003e Not applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData will be made available upon request made to the corresponding author.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors confirm that they do not have any conflicts of interest to disclose.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research did not receive any funding from any government or private institutions.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePM \u0026nbsp;and ST were involved in the conceptualization of the study in discussion with HSJC. PM and ST contributed to data management and analysis for the study. PM drafted the manuscript. All authors have read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number\u003c/strong\u003e: not applicable.\u003c/p\u003e\n\u003cp\u003eAuthors\u0026apos; information (optional)\u003c/p\u003e\n\u003cp\u003eDr. Helen shaji \u0026nbsp;J C \u0026nbsp;- Orcid I\u0026apos;d :0000-0003-3006-2029\u003c/p\u003e\n\u003cp\u003ePriyadharsini. M - Orcid I\u0026apos;d :0009-0001-1693-6423\u003c/p\u003e\n\u003cp\u003eDr. T. Suseelal - Orcid I\u0026rsquo;d: 0000-0002-0353-5023\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eThurlow JS, Joshi M, Yan G, Norris KC, Agodoa LY, Yuan CM, et al. Global Epidemiology of End-Stage Kidney Disease and Disparities in Kidney Replacement Therapy. 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Int J Environ Res Public Health. 2020;17:6552. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3390/IJERPH17186552\u003c/span\u003e\u003cspan address=\"10.3390/IJERPH17186552\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eJavanbakhtian Ghahfarokhi R, Abbaszadeh A. The relationship between quality of life and demographic variables in hemodialysis patients. J Jahrom Univ Med Sci. 2012;10:1\u0026ndash;7. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.29252/JMJ.10.3.1\u003c/span\u003e\u003cspan address=\"10.29252/JMJ.10.3.1\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Table 5","content":"\u003cp\u003eTable 5 is available in the Supplementary Files section.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"End-stage renal disease (ESRD), Hemodialysis, Health-related quality of life (HRQOL), Demographic characteristics, Kidney Disease Quality of Life (KDQOL), Patient outcomes","lastPublishedDoi":"10.21203/rs.3.rs-7538130/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7538130/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eEnd-stage renal disease (ESRD) requires hemodialysis, which significantly impacts multiple aspects of patient well-being. Understanding how demographic factors influence health-related quality of life (HRQOL) in this population is crucial for developing effective interventions. This study aims to assess the effect of demographic characteristics—age, sex, education, and occupation—on HRQOL in patients undergoing hemodialysis.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eA cross-sectional study was conducted among 44 adults receiving biweekly hemodialysis at a tertiary hospital in Tamil Nadu, India. Patients included were over 20 years old and had been on maintenance hemodialysis for at least six months. HRQOL was measured using the Kidney Disease Quality of Life (KDQOL) instrument, encompassing physical, mental, and disease-specific domains. Data collection involved structured interviews and observational checklists. Statistical analysis included descriptive statistics and the chi-square test to evaluate the association between demographic variables and HRQOL.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eAmong the participants, 79.5% were classified as having good quality of life and 20.5% as fair. Educational level and occupational status were significantly associated with HRQOL (p \u0026lt; 0.05). Patients aged above 50 years reported a higher burden of symptoms, while male participants achieved better physical health scores, and female participants achieved higher mental health scores. Most patients were unemployed and had only primary education. All patients fell into a low-income category and had comorbid diabetes and hypertension. No participants were classified as having poor quality of life.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions: \u003c/strong\u003eDemographic characteristics, particularly education and employment status, play a crucial role in shaping HRQOL for individuals on hemodialysis. Tailored interventions addressing educational and occupational barriers, alongside medical care, are essential to enhance patient quality of life and overall well-being.\u003c/p\u003e","manuscriptTitle":"`4exploring Factors Affecting Health-related Quality of Life Among Hemodialysis Patients","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-03 01:07:22","doi":"10.21203/rs.3.rs-7538130/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"9ee47f5a-c290-4a04-8d32-acbf934f361b","owner":[],"postedDate":"October 3rd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-02-23T14:26:47+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-03 01:07:22","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7538130","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7538130","identity":"rs-7538130","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}