Supportive Care Needs and Associated Factors in Hemodialysis Patients: A Cross-Sectional Study

Supportive Care Needs and Associated Factors in Hemodialysis Patients: A Cross-Sectional Study | 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 Supportive Care Needs and Associated Factors in Hemodialysis Patients: A Cross-Sectional Study Sijia Chen, Xiuming Zhao, Hongyan Niu, Xiying Zhu This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7478622/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) presents significant challenges for patients undergoing hemodialysis, characterized by high morbidity and complex care needs. This study aimed to systematically assess the supportive care needs of hemodialysis patients and analyze the associated influencing factors to provide a scientific basis for developing a precise nursing intervention system aimed at improving long-term prognosis and quality of life. Methods A total of 550 hemodialysis patients were recruited from the First People’s Hospital of Changzhou from December 2024 to March 2025, with 502 valid questionnaires collected using a convenience sampling method. The research utilized a demographic questionnaire, the Supportive Care Needs Survey (SCNS), and the Karnofsky Performance Scale (KPS) for data collection. Statistical analysis was performed using SPSS 25.0, with a focus on descriptive statistics, one-way ANOVA, independent samples t-tests, and multiple linear regression to identify factors impacting supportive care needs. Results The results indicated that the overall supportive care needs score was 109.64 ± 31.92, reflecting a moderately high level, with significant needs identified in practical support and information-related areas. Factors such as marital status, economic burden, access route type, primary disease, and duration of dialysis significantly influenced these needs. Conclusions The study concludes that hemodialysis patients exhibit a moderate to high level of supportive care needs, particularly regarding practical and informational demands. Future clinical practice should focus on constructing a phased precision intervention system that targets distinct stages of dialysis, emphasizing economic assistance, treatment guidance, and comprehensive support to transition from “disease management” to “holistic care,” thereby enhancing patient quality of life and treatment adherence. Further longitudinal studies are warranted to explore the dynamic changes in supportive care needs over time. end-stage renal disease hemodialysis Supportive care needs Introduction The increasing prevalence of end-stage renal disease (ESRD) globally, coupled with the growing aging population, has led to an urgent need for comprehensive care strategies tailored for hemodialysis patients. This demographic often faces a myriad of physical, emotional, and social challenges that significantly impact their quality of life. Supportive care needs, defined as the totality of assistance beyond medical treatment that patients require during their illness, have emerged as a critical area of focus in the management of chronic diseases, including ESRD [ 1 ]. As the complexity of care continues to evolve, integrating supportive care into standard treatment protocols is essential to ensure that patients receive holistic and patient-centered care[ 2 ]. Despite the recognition of the importance of supportive care, research into the specific needs of hemodialysis patients remains insufficient. A limited number of studies have systematically assessed the supportive care needs within this population, often focusing on technical aspects of dialysis and the management of complications rather than the broader psychosocial dimensions of care [ 3 ]. Furthermore, existing literature indicates that a significant proportion of hemodialysis patients experience unmet needs, particularly in areas related to emotional support, information, and financial assistance[ 4 ]. A study highlighted that factors such as uncertainty, depression, and social support significantly influence self-care compliance among patients undergoing hemodialysis. The findings indicated that patients who experience higher levels of uncertainty tend to exhibit lower self-care compliance, underscoring the need for targeted interventions aimed at reducing uncertainty and enhancing self-care through education and accurate information dissemination[ 5 ].Moreover, Liu et al. (2022) explored the role of care partners in supporting the mobility of older adults on hemodialysis, revealing that these partners often witness a decline in mobility and provide essential support. This highlights the critical role of caregivers in the hemodialysis setting and suggests that interventions aimed at empowering care partners could improve patient outcomes[ 6 ]. Additionally, a qualitative study conducted by Ferreira da Silva et al. (2021) emphasized the necessity of improving information delivery in hemodialysis care, as inadequate communication can lead to confusion and decreased patient satisfaction[ 7 ].The need for holistic approaches to care is further evidenced by research focusing on the lived experiences of hemodialysis patients, which reveals that many face significant emotional and physical challenges. For instance, Alzahrani et al. (2023) found that patients often struggle with social isolation and fatigue, indicating a pressing need for comprehensive support systems that address both physical and emotional well-being[ 8 ].This gap in understanding highlights the necessity for targeted research that examines the unique challenges faced by this patient population and identifies the factors influencing their supportive care needs. The methodology employed in this study utilizes a cross-sectional design, which is particularly advantageous for capturing a snapshot of the current state of supportive care needs among hemodialysis patients. A convenience sampling approach allows for the inclusion of a diverse cohort of patients from various backgrounds, thereby enhancing the generalizability of the findings. The use of validated assessment tools, such as the Supportive Care Needs Survey (SCNS), facilitates a comprehensive evaluation of patients’ needs across multiple dimensions, including physical, psychological, and informational support [ 9 ]. By employing robust statistical analyses, the study aims to elucidate the relationships between demographic, clinical, and psychosocial factors that may contribute to variations in supportive care needs. The objectives of this research are twofold: firstly, to systematically assess the current status of supportive care needs among hemodialysis patients, and secondly, to analyze the associated factors that may influence these needs. By achieving these objectives, the study seeks to provide a foundation for developing a more precise and individualized supportive care intervention framework, ultimately aiming to improve patient outcomes and enhance the quality of life for individuals undergoing hemodialysis. This research is anticipated to contribute valuable insights into the design of comprehensive care models that address not only the medical but also the psychosocial aspects of patient care, aligning with contemporary healthcare paradigms that emphasize patient-centered approaches[ 10 ]. Methods Study design and participants A cross-sectional study was conducted using a structured self-report questionnaire. The Strengthening the Reporting of Observation studies in Epidemiology (STROBE) checklist for cross-sectional studies was followed to ensure comprehensive reporting. Data collection took place at Changzhou First People's Hospital between December 2024 and March 2025. Participants were recruited via convenience sampling. Inclusion criteria were: (a) diagnosed with end-stage chronic kidney disease undergoing hemodialysis; (b) aged ≥ 18 years; (c) able to communicate effectively and comprehend questionnaires; and (d) provided informed consent. Exclusion criteria were: (a) patients requiring temporary hemodialysis for acute conditions (e.g., acute liver failure, refractory heart failure); (b) patients with severe comorbidities (e.g., malignancy, active severe infection); and (c) patients with diagnosed psychiatric disorders. The sample size was calculated using the formula proposed by Ni Ping[ 11 ], which recommends 10–20 times the number of items in the primary scale. The main instrument (Supportive Care Needs Survey, SCNS) contained 36 items. Accounting for a 10% invalid response rate, the required sample size ranged between 396 and 792. A target sample size of 550 was set to ensure adequate power. Measurements The questionnaire comprised three sections: Sociodemographic and Clinical Characteristics Sheet: Researcher-designed based on literature review[ 12 – 24 ], collecting data on demographics (gender, age, residence, marital status, employment, education, income), disease characteristics (primary diagnosis, dialysis vintage, dialysis frequency), and psychosocial status. Supportive Care Needs Survey (SCNS): A validated 36-item scale developed by Gai Tiantian[ 15 ] specifically for hemodialysis patients. It assesses needs across seven domains: Physical (5 items), Psychological (5 items), Social (6 items), Emotional (5 items), Spiritual (4 items), Informational (7 items), and Practical (4 items). Items are rated on a 5-point Likert scale (1 = "No need" to 5 = "High need"). The scale demonstrated good internal consistency, with Cronbach's α coefficients for the domains ranging from 0.891 to 0.937 in previous validation . Karnofsky Performance Status (KPS) Scale Score[ 25 ]: Assessed by the researcher. This scale evaluates functional status and dependency levels (score range: 0-100; 100 = normal function, 0 = death). Scores were categorized as: Dependent (≤ 50), Semi-dependent (50–70), or Independent (≥ 80). Data Collection Procedure Following approval by the hospital ethics committee, potential participants were approached during their dialysis sessions. The study purpose, procedures, and significance were explained. Written informed consent was obtained from all participants. Trained research assistants administered the questionnaires. Participants self-completed the sociodemographic sheet and SCNS. For participants with visual or other impairments preventing self-completion but with intact cognition, the research assistant read the items aloud and recorded their responses. The KPS score was assessed by the researcher. Questionnaires were checked for completeness upon collection, with immediate clarification sought for missing items. Average completion time was 10–15 minutes. Statistical Analysis Data were entered into Excel and verified by two independent researchers. Statistical analyses were performed using SPSS version 25.0. Descriptive statistics were used: frequencies and percentages (%) for categorical variables; means and standard deviations (x̄±SD) for normally distributed continuous variables. Group differences in SCNS total score were analyzed using independent samples t-tests or one-way Analysis of Variance (ANOVA) for categorical independent variables with two or more than two groups, respectively. Variables showing statistically significant associations (P < 0.05) in univariate analyses were entered into a multiple linear regression model to identify independent predictors of supportive care needs. Statistical significance was set at P < 0.05. Ethical Considerations The study protocol was approved by the Ethics Committee of Changzhou First People's Hospital (statement number 2024(Research)CL109-01). All participants provided written informed consent after receiving detailed information about the study. Confidentiality was maintained throughout data handling and storage, with data disposed of according to institutional guidelines. Participants were informed of their right to withdraw at any time without consequence. Results Participant Characteristics A total of 550 questionnaires were distributed, with 502 valid responses collected, resulting in a response rate of 91.27%. The majority of participants were male (63.5%), with an average age of 56.63 ± 13.505 years. The demographic and clinical characteristics of the participants are presented in Table 1 . Table 1 Demographic and Clinical Characteristics of Participants(n = 502) Category n Mean ± SD t / F P Dialysis Vintage (years) 9.978 10 years 123 103.68 ± 32.48 Marital Status 2.738 0.043 Married 400 110.93 ± 31.74 Unmarried 36 106.19 ± 31.11 Divorced 45 109.56 ± 33.23 Widowed 21 91.14 ± 29.67 Educational Level 2.676 0.031 Elementary School 69 119.90 ± 31.90 Middle School 162 105.20 ± 30.34 High School or Vocational 147 110.19 ± 32.67 College 67 107.87 ± 28.89 Bachelor's Degree or Above 57 110.51 ± 35.64 Primary Caregiver 0.446 0.640 Spouse 303 110.57 ± 31.77 children 92 107.01 ± 33.47 Other 107 109.27 ± 31.09 Family Monthly Income (RMB) 0.668 0.572 ≤ 1000 45 114.89 ± 34.81 1001–3000 183 108.03 ± 32.97 3001–5000 161 108.94 ± 29.87 >5000 113 111.14 ± 31.94 Insurance Type 2.399 0.049 Self-Pay 7 106.00 ± 28.42 Employee Insurance 382 107.39 ± 32.16 Resident Insurance 72 117.67 ± 28.83 New Rural Cooperative 34 119.00 ± 35.25 Other 7 108.00 ± 16.61 Economic Burden 5.261 0.001 Low 46 97.85 ± 29.38 Moderate 273 107.71 ± 30.39 High 148 113.88 ± 32.17 Very High 35 122.29 ± 39.29 Dialysis Frequency 3.792 0.010 2 times/week 39 108.49 ± 31.30 3 times/week 440 108.99 ± 31.77 > 3 times/week 20 117.65 ± 31.27 Other 3 167.00 ± 4.36 Dialysis Access Type 8.116 0.000 arteriovenous fistula 415 107.15 ± 31.12 graft arteriovenous fistula 18 114.17 ± 31.72 Catheter 69 123.43 ± 33.44 Primary Disease 3.527 0.004 Glomerulonephritis 102 102.46 ± 34.10 Diabetic Nephropathy 114 118.51 ± 33.23 Hypertensive Nephropathy 156 109.12 ± 30.00 Systemic Lupus Erythematosus 5 129.40 ± 31.13 Polycystic Kidney Disease 34 110.82 ± 31.65 Other 91 105.93 ± 28.69 Comorbidities 1.812 0.125 None 90 107.32 ± 30.62 1 218 107.39 ± 32.72 2 128 110.38 ± 31.43 3 40 118.10 ± 35.04 ≥ 4 25 120.28 ± 23.99 Gender 1.183 0.237 Male 319 110.92 ± 31.96 Female 183 107.42 ± 31.80 Residence -0.174 0.862 Rural 119 109.19 ± 34.72 Urban 383 109.78 ± 31.04 Employment Status -0.523 0.601 Employed 88 108.02 ± 31.13 Unemployed 414 109.98 ± 32.10 KPS Score 6.920 0.001 Dependent (< 50) 34 124.00 ± 34.27 Semi-Independent (50–70) 172 113.39 ± 30.98 Independent (≥ 80) 296 105.81 ± 31.55 Age (years) 1.847 0.119 18–44 104 107.82 ± 31.61 45–59 194 112.11 ± 30.04 60–74 149 111.11 ± 34.75 75–89 53 99.58 ± 29.61 ≥ 90 2 121.00 ± 36.77 Table 2 Supportive Care Needs Scores of Hemodialysis Patients (n = 502) Dimension Items Minimum Maximum Total Score Item Score Ranking Total Score 36 36 180 109.64 ± 31.92 3.05 ± 0.89 Physiological Needs 5 5 25 16.20 ± 4.81 3.24 ± 0.96 3 Psychological Needs 5 5 25 14.51 ± 5.63 2.90 ± 1.13 5 Social Needs 6 6 30 16.17 ± 6.33 2.70 ± 1.05 7 Emotional Needs 5 5 25 13.93 ± 5.59 2.79 ± 1.12 6 Spiritual Needs 4 4 20 11.65 ± 4.05 2.91 ± 1.01 4 Information Needs 7 7 35 23.08 ± 6.96 3.30 ± 0.99 2 Practical Needs 4 4 20 14.10 ± 3.84 3.53 ± 0.96 1 Table 3 Top 10 Supportive Care Needs Items of Hemodialysis Patients (n = 502) Item Item Score Dimension G4 Help me reduce medical expenses and alleviate economic burden 3.63 ± 1.16 Practical Needs G2 Ensure the hemodialysis process is safe and effective, with timely response to machine alarms 3.56 ± 1.09 Practical Needs A3 Provide a scientific and reasonable medication regimen 3.52 ± 1.08 Physiological Needs F5 Offer guidance on symptom control and complication prevention 3.49 ± 1.09 Information Needs G3 Provide support to my family if they need help in managing my illness 3.47 ± 1.08 Practical Needs G1 Create a quiet and comfortable treatment environment for me 3.45 ± 1.15 Practical Needs F6 Educate me on the protection of vascular access (e.g., arteriovenous fistula or catheter) 3.44 ± 1.13 Information Needs E2 Seek my opinion before conducting related examinations or treatments 3.41 ± 1.12 Spiritual Needs A5 Assist me in controlling primary diseases and slowing disease progression 3.38 ± 1.16 Physiological Needs F2 Explain the purpose and significance of the examinations or treatments I need 3.37 ± 1.10 Information Needs Supportive Care Needs of Hemodialysis Patients The total score of supportive care needs for hemodialysis patients was 109.64 ± 31.92, with an item mean score of 3.05 ± 0.89, indicating a moderate to high level of need. Among the seven dimensions of needs, the highest item mean scores were observed in the dimensions of practical needs (3.53 ± 0.96) and informational needs (3.30 ± 0.99). The lowest item mean score was found in the social needs dimension (2.70 ± 1.05). The top ten items with the highest mean scores are listed in Table 3 . Univariate Analysis of Supportive Care Needs Univariate analysis revealed that factors such as dialysis duration, marital status, educational level, medical insurance type, economic burden, dialysis frequency, dialysis access type, primary disease, and KPS score significantly influenced the supportive care needs of hemodialysis patients (P < 0.05). Patients with a shorter dialysis duration (≤ 1 year) had higher need scores than those with longer dialysis durations. Patients who were widowed had significantly lower need scores than those who were married. Patients with lower educational levels reported higher need scores. Patients with medical insurance types such as residents' medical insurance and new rural cooperative medical schemes had higher need scores. Patients experiencing a greater economic burden reported higher need scores. Patients with dialysis frequencies exceeding three times per week had higher need scores. Patients using dialysis catheters had higher need scores than those with arteriovenous fistulas. Patients with diabetic nephropathy as the primary disease had higher need scores. Patients with lower KPS scores had higher need scores. Multivariate Linear Regression Analysis Multivariate linear regression analysis was performed with the total supportive care needs score as the dependent variable and the factors with statistical significance in the univariate analysis as independent variables. The results indicated that marital status, economic pressure, dialysis access type, primary disease, and dialysis duration were the main factors influencing the supportive care needs of hemodialysis patients. Economic pressure had the strongest impact, with patients experiencing very high economic pressure having a significantly higher needs score than those with lower economic pressure. Patients who were widowed had a significantly lower needs score than those who were married. Patients using dialysis catheters had a higher needs score than those with arteriovenous fistulas. Patients with diabetic nephropathy as the primary disease had a significantly higher needs score than those with other primary diseases. Patients with a dialysis duration of 6–10 years had a significantly lower needs score than those with a shorter dialysis duration. The regression model explained 17.7% of the variance in supportive care needs scores. Table 4 Variables and Dummy Variable Coding for Multivariate Linear Regression Analysis (n = 502) Variable Category Dummy Coding Dialysis Vintage ≤ 1 year 1 2–5 years 2 6–10 years 3 > 10 years 4 Marital Status Married 1 Unmarried 2 Divorced 3 Widowed 4 Educational Level Elementary School 1 Middle School 2 High School or Vocational 3 College 4 Bachelor’s Degree or Above 5 Insurance Type Self-Pay 1 Employee Insurance 2 Resident Insurance 3 New Rural Cooperative 4 Other 5 Economic Burden Low 1 Moderate 2 High 3 Very High 4 Dialysis Frequency 2 times/week 1 3 times/week 2 > 3 times/week 3 Other 4 Dialysis Access Type Native Arteriovenous Fistula 1 Graft Arteriovenous Fistula 2 Catheter 3 Primary Disease Glomerulonephritis 1 Diabetic Nephropathy 2 Hypertensive Nephropathy 3 Systemic Lupus Erythematosus 4 Polycystic Kidney Disease 5 Other 6 KPS Score Dependent (< 50) 1 Semi-Independent (50–70) 2 Independent (≥ 80) 3 Table 5 Multiple Linear Regression Analysis of Factors Influencing Supportive Care Needs in Hemodialysis Patients (n = 502) Variable B SE β ′ t P Constant 112.085 15.064 7.441 0 Marital Status (Widowed vs. Married) -25.37 6.885 -0.159 -3.685 < 0.001 Economic Pressure (High vs. Low) 13.892 5.313 0.199 2.615 0.009 Economic Pressure (Very High vs. Low) 20.49 7.071 0.164 2.898 0.004 Dialysis Access Type (Catheter vs. Native AV Fistula) 8.663 4.141 0.094 2.092 0.037 Primary Disease (Diabetic Nephropathy vs. Glomerulonephritis) 12.154 4.359 0.16 2.788 0.006 Dialysis Vintage (6–10 years vs. ≤1 year) -18.157 4.722 -0.22 -3.845 10 years vs. ≤1 year) -14.836 4.621 -0.2 -3.21 0.001 Note: AV = Arteriovenous. R² = 0.177, Adjusted R² = 0.127, F = 3.508, p < 0.001. Discussion The prevalence of end-stage renal disease (ESRD) continues to rise globally, posing significant health challenges for affected individuals. Hemodialysis, a common treatment modality for ESRD, often leads to various physical, emotional, and social burdens due to the chronic nature of the disease. Patients frequently experience a high symptom burden, economic stress, and disruptions in their daily lives, which can significantly affect their overall quality of life. Moreover, as the demographic profile of patients with ESRD evolves, with an increasing number of elderly and co-morbid patients, the complexity of their care needs has become more pronounced. Research indicates that unmet supportive care needs are prevalent in this population, highlighting the critical need for integrated palliative and supportive care approaches tailored to individual patient circumstances and preferences[ 26 , 27 ]. This study aims to systematically assess the supportive care needs of patients undergoing hemodialysis and identify the factors influencing these needs. By employing a cross-sectional design, we surveyed 550 patients at a local hospital, gathering data on demographics, clinical characteristics, and supportive care needs using validated instruments. Our findings reveal that hemodialysis patients express moderate to high levels of supportive care needs, with particular emphasis on practical and informational support. Furthermore, various demographic and clinical factors, such as economic burden, marital status, dialysis access type, primary disease, and dialysis vintage, significantly influence the extent of these needs. The following discussion will delve into the implications of these findings for designing targeted interventions to enhance the quality of care and overall well-being of patients receiving hemodialysis[ 10 , 28 ]. This study revealed that the total score for supportive care needs among hemodialysis patients was 109.64 ± 31.92 (Table 1 ), indicating a moderately high level of need. This finding is consistent with similar domestic studies [ 15 ]. Analysis of domain scores identified practical needs and informational needs as the top two priorities. Notably, “reducing medical costs”and “ensuring hemodialysis procedure safety” represented particularly urgent demands, reflecting the core significance of economic pressure and treatment safety for this population. Although psychological/spiritual needs scored lower overall, the specific item “soliciting patient opinions before relevant tests/treatments”still ranked within the top eight. This suggests a potential latent need for greater participation in medical decision-making that may not be fully addressed.Compared to prior research, a key innovation of this study lies in establishing the priority ranking of specific needs through item analysis. For instance, items related to economic burden (G4, G2) occupied the top two positions, while items concerning psychological support did not rank within the top ten. This result challenges the conventional view that psychological intervention is a core need for dialysis patients. A plausible explanation is that within a resource-constrained healthcare environment, patients prioritize addressing“survival-driven needs” (such as cost and treatment safety) that have a direct and immediate impact on their survival. Psychological concerns may be temporarily suppressed or attributed to external circumstances under these pressures. The strong association between economic burden and higher supportive care needs (β = 0.199 for high burden, β = 0.164 for very high burden) underscores the profound impact of financial stress on patients’ well-being. Both univariate and multivariate analyses identified economic pressure as the strongest predictor of elevated supportive care needs. Patients reporting a “very high” economic burden had a significantly higher needs score of 122.29 ± 39.29 compared to other groups (P = 0.001). This resonates with global studies highlighting that out-of-pocket costs for dialysis, medications, and transportation exacerbate psychological distress and reduce treatment adherence[ 29 – 32 ]. Furthermore, within the multivariate model, patients experiencing “high” and “very high” economic pressure demonstrated total needs scores 13.9 times and 20.5 times higher, respectively, than those with "low" economic pressure (P < 0.05). This study further elucidates the dual pathways through which economic pressure impacts needs: Directly increasing practical needs: Primarily manifested as demands for reduced medical costs. Indirectly exacerbating psychological burden: Such as anxiety related to medical debt. Notably, the influence of health insurance type in China presents unique characteristics. Patients enrolled in Urban Resident Basic Medical Insurance (URBMI) and the New Rural Cooperative Medical Scheme (NCMS) exhibited significantly higher needs scores than those covered by Urban Employee Basic Medical Insurance (UEBMI). This disparity is likely attributable to differences in reimbursement rates and scope of coverage between these insurance schemes. Optimizing the tiered design of health insurance coverage and implementing targeted subsidies for low-income and rural patients emerge as crucial strategies for addressing this issue. Patients with diabetic nephropathy (DN) as their primary kidney disease demonstrated significantly higher total supportive care needs scores (118.51 ± 33.23) compared to groups with other primary diseases (P = 0.006). Multivariate analysis further confirmed its independent effect as a risk factor (β = 12.15). Potential mechanisms underlying this elevated need include: Diabetes mellitus acts as the primary disease that induces nephropathy, which in turn drives multisystem complications, ultimately forming a bidirectional vicious cycle[ 33 ]; Increased Multisystem Involvement: DN is frequently complicated by multisystem damage, such as cardiovascular disease and neuropathy, leading to greater overall treatment complexity. Managing both diabetes-related parameters (e.g., blood glucose, hypertension) and dialysis-specific protocols creates a dual care burden, substantially intensifying self-management requirements[ 34 ].Furthermore, patients with systemic lupus erythematosus (SLE) exhibited notably high needs scores (129.40 ± 31.13). However, due to the limited sample size in this subgroup (n = 5), these findings must be interpreted with caution. Future research should aim to enroll larger samples of patients with less common primary kidney diseases to validate the existence and nature of any disease-specific needs profiles. Patients' supportive care needs exhibit dynamic changes as dialysis duration increases. Patients with a dialysis vintage of ≤ 1 year had the highest total need score (123.67 ± 34.14), while the 6–10 years group scored the lowest (100.87 ± 28.22). Multivariate modeling revealed a significant negative association between the needs score of the 6–10 year dialysis vintage group and the ≤ 1 year reference group (P < 0.001). Patients in the initial phase require substantial support for disease knowledge acquisition, skill development, and psychological adaptation [ 35 ]. As treatment duration extends, patients may experience reduced needs through adaptation to the disease and the establishment of support networks. However, the needs of the > 10 years dialysis vintage group showed a slight increase (103.68 ± 32.48), potentially related to the accumulation of long-term complications and "treatment fatigue." This finding supports the "dynamic needs model," indicating that patient needs do not decline linearly but fluctuate throughout the disease course. In clinical practice, interventions should be tailored according to the patient's dialysis stage. Leveraging the Information-Motivation-Behavioral Skills (IMB) model can continuously enhance self-management capabilities, while establishing a nurse-led "hub-and-satellite" collaborative network facilitates resource sharing. Regarding intervention timing, early-stage efforts should intensify patient education, the mid-stage should focus on psychosocial adaptation, and the late-stage should prioritize symptom control and advance care planning. Cultural adaptation tools should be employed concurrently to reduce decision-making disparities. Despite the relatively low mean score in the social needs domain (2.70 ± 1.05), a counterintuitive finding emerged: widowed patients demonstrated significantly lower total supportive care needs scores compared to their married counterparts (P < 0.001). This paradoxical observation may arise from two potential mechanisms related to disrupted social support networks: Widowed patients may underreport actual needs due to reluctance to seek assistance stemming from perceived stigma or self-reliance. Latent psychosocial needs may be displaced and expressed as heightened demands in other domains, most notably practical care requirements. Furthermore, the primary caregiver's relationship to the patient (spouse vs. adult child) did not significantly predict needs scores. This null finding likely reflects culturally embedded caregiving dynamics within Chinese familial structures. Patients receiving care from either spouses or children demonstrated consistent suppression of need expression—potentially to preserve familial harmony or avoid perceptions of being burdensome within intergenerational relationships. The use of catheters (compared to arteriovenous fistulas) is associated with increased needs (β = 0.094, p = 0.037). Physiologically, the catheter, as a foreign body, continuously irritates the vascular wall, triggering the release of inflammatory cytokines which exacerbate symptoms like fatigue and pain. Psychosocially, the visible catheter segment impacts body image, and restrictions on activities such as bathing impair social participation. Study [ 36 ]revealed that catheter users experience infection and thrombosis complication rates as high as 1.3 episodes per year, necessitating frequent hospital visits, antibiotic therapy, and catheter replacements. Patients with femoral vein catheters face an even higher catheter-related infection rate of 27%, increasing emergency department visits and hospitalization demands. Inadequate catheter flow leads to inadequate dialysis and necessitates frequent imaging assessments. Bathing restrictions and the exposed catheter requiring specialized waterproof devices (e.g., catheter protective sleeves) contribute to reduced self-care capacity [ 37 ]. Consequently, the higher risk of complications and restricted mobility directly elevate the need for medical interventions, daily living assistance, psychosocial support, and financial aid. while earlier works have documented the physical and psychological challenges faced by these patients, they often overlooked the nuanced understanding of their support needs, particularly in economic and informational aspects, which emerged as critical factors in our study[ 26 , 27 ]. The prominence of practical needs (e.g., reducing medical costs, ensuring treatment safety) and informational needs (e.g., symptom control guidance, vascular access education) as top priorities echoes Ferreira da Silva et al.’s emphasis on communication gaps in hemodialysis care [ 7 ] and Liu et al.’s call for enhanced patient education [ 6 ]. This reinforces the necessity of shifting from disease-centered to holistic, patient-centered care models that address socioeconomic and informational vulnerabilities [ 2 , 5 ]. The implications of our findings extend beyond the individual patient level, influencing clinical practice and health policy. The identification of economic burden as a significant predictor of supportive care needs suggests that healthcare systems must prioritize the integration of financial assistance into the care continuum for hemodialysis patients. This could include developing targeted strategies to alleviate financial strain, such as enhancing access to social services or adjusting insurance coverage policies. Furthermore, the recognition of specific needs related to various primary diseases indicates that personalized care plans should be developed, focusing not only on the medical management of renal disease but also on the holistic well-being of patients[ 28 , 38 ]. Such a comprehensive approach could enhance treatment adherence and overall patient quality of life, thereby potentially improving clinical outcomes. However, this study is not without its limitations, which must be acknowledged to contextualize our findings accurately. The cross-sectional design inherently restricts our ability to assess the dynamic changes in supportive care needs over time. Additionally, the convenience sampling method may limit the generalizability of our results to the broader hemodialysis population. Future longitudinal studies are warranted to explore how supportive care needs evolve throughout the treatment journey and how these changes correlate with patient outcomes[ 39 , 40 ]. Addressing these limitations in subsequent research will provide a more comprehensive understanding of the factors influencing supportive care needs and inform the development of more effective interventions tailored to individual patient profiles. Conclusion In conclusion, this study highlights that the supportive care needs of hemodialysis patients are generally at a moderately high level, with particular emphasis on practical and informational needs. The findings underscore the necessity for a tailored, phase-specific intervention framework that addresses the unique challenges faced by patients at various stages of treatment. By prioritizing economic assistance and treatment guidance for newly initiated dialysis patients, and focusing on complications prevention and psychological support for long-term patients, healthcare providers can enhance patient quality of life and adherence to treatment regimens. Ultimately, a shift from a purely disease management approach to one that encompasses holistic care is essential for improving the overall well-being of hemodialysis patients. Declarations Funding This research was funded by grants from research fund of Changzhou First People's Hospital (No: yy2023015). Author Contribution XM.Z. oversaw and directed the study. SJ.C. and XM.Z. authored the manuscript. SJ.C. and XY. Z. executed the data collection protocol. HY.N interpreted the data, conducted statistical analysis. All authors approved the final manuscript. Acknowledgements The authors express gratitude to patients participating in the survey. 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Rehabil Nurs 28(4):109–116. https://doi.org/10.1002/j.2048-7940.2003.tb01727.x Kalra S, Jena B N, Yeravdekar R (2018) Emotional and Psychological Needs of People with Diabetes. Indian J Endocrinol Metab 22(5):696–704. https://doi.org/10.4103/ijem.IJEM_579_17 Ping Ni,Jingli Chen,Na Liu (2010) The sample size estimation in quantitative nursing research[J].Chinese Journal of Nursing 45(04):378–380. https://kns.cnki.net/kcms2/detail?v=IKKGlZ0AkeUudELZub_nJrRJiGUxFV8iUCGjlid-BYnTo4o 9gw_ZQ7DgIHsiH-MDzdobjBDNY9YK3dkuAHFH2fJHHnxTIXK9jPo3WNs8APW5pV_w5Ypx1l3dJyOFwaE_&uniplatform=CHKD&language=CHS Li ZY, Ding R, Bai JY, et al. Psychological status and care needs of maintenance hemodialysis patients: A qualitative study[J]. Chinese Journal of Modern Nursing, 2022,28(24):3256–3259. Chinese. Li MQ, Li LS, Bai XX, et al. Real experiences and care needs of patients surviving more than 5 years on maintenance dialysis: A qualitative study[J]. Chongqing Medicine, 2022,51(12):2153–2157. Chinese. Current status and influencing factors of pre-dialysis decision-making participation needs in patients with chronic kidney disease[J]. Chinese Nursing Research, 2021,35(7):1156–1161. Chinese. Gai Tiantian. (2021). Development and application of a supportive care needs scale for maintenance hemodialysis patients (Doctoral dissertation). Tianjin University of Traditional Chinese Medicine, Tianjin, China. Lu XH, Yao JP, Wei J, et al. Investigation of nursing needs in induction-phase hemodialysis patients[J].Chinese Journal of Nursing, 2004(9):68–70. Chinese. Brown E A, Zhao J, McCullough K, et al. Burden of Kidney Disease, Health-Related Quality of Life, and Employment Among Patients Receiving Peritoneal Dialysis and In-Center Hemodialysis: Findings From the DOPPS Program[J]. Am J Kidney Dis, 2021,78(4):489–500. Xhulia D, Gerta J, Dajana Z, et al. Needs of Hemodialysis Patients and Factors Affecting Them[J]. Glob J Health Sci, 2015,8(6):109–120. Shih C, Huang C, Huang M, et al. The association of sociodemographic factors and needs of haemodialysis patients according to Maslow's hierarchy of needs[J]. J Clin Nurs, 2019,28(1–2):270–278. Gutiérrez Sánchez D, Leiva-Santos J P, Cuesta-Vargas A I. Symptom Burden Clustering in Chronic Kidney Disease Stage 5[J]. Clin Nurs Res, 2019,28(5):583–601. Le Leu R, Bennett P N, Dansie K, et al. Changes in symptom burden in the first 6 months after dialysis commencement: a prospective longitudinal observational cohort study[J]. J Nephrol, 2023,36(5):1485–1488. Lee K, Song H C, Choi E J, et al. Posttraumatic Embitterment Disorder in Patients with Chronic Kidney Disease[J]. Clin Psychopharmacol Neurosci, 2019,17(2):183–188. Oberoi D, White V M, Seymour J F, et al. The influence of unmet supportive care needs on anxiety and depression during cancer treatment and beyond: a longitudinal study of survivors of haematological cancers[J]. Support Care Cancer, 2017,25(11):3447–3456. Wang X, Shi Q, Mo Y, et al. Palliative care needs and symptom burden in younger and older patients with end-stage renal disease undergoing maintenance hemodialysis: A cross-sectional study[J]. Int J Nurs Sci, 2022,9(4):422–429. Liu Min, Zhang Lu, Sun Lihua, et al. Analysis of KPS Score Status of Chemotherapy Patients in Liaoning Province [J]. China Cancer, 2013, 22(8): 635–637. Gelfand S L, Scherer J S, Koncicki H M. Kidney Supportive Care: Core Curriculum 2020[J]. Am J Kidney Dis, 2020,75(5):793–806. Berzoff J, Swantkowski J, Cohen L M. Developing a renal supportive care team from the voices of patients, families, and palliative care staff[J]. Palliat Support Care, 2008,6(2):133–139. Lloyd-Williams M, Abba K, Crowther J. Supportive and palliative care for patients with chronic mental illness including dementia[J]. Curr Opin Support Palliat Care, 2014,8(3):303–307. Liu X, Mao Y, Wang H, et al. Path Analysis on Medical Expenditures of 855 Patients with Chronic Kidney Disease in a Hospital in Beijing[J]. Chin Med J (Engl), 2018,131(1):25–31. Baghdadi L R, Alsaiady M M. Medication Adherence Barriers and Their Relationship to Health Determinants for Saudi Pediatric Dialysis Patients[J]. Children (Basel), 2024,11(3). Omranikhoo H, Shabani S, Esfandiari A, et al. Economic burden of end stage renal disease: a case study in southern Iran[J]. Health Econ Rev, 2025,15(1):51. Kassa D A, Mekonnen S, Kebede A, et al. Cost of Hemodialysis Treatment and Associated Factors Among End-Stage Renal Disease Patients at the Tertiary Hospitals of Addis Ababa City and Amhara Region, Ethiopia[J]. Clinicoecon Outcomes Res, 2020,12:399–409. Ren X, Kang N, Yu X, et al. Prevalence and association of diabetic nephropathy in newly diagnosed Chinese patients with diabetes in the Hebei province: A single-center case-control study[J]. Medicine (Baltimore), 2023,102(11):e32911. Hanspal I, Fathima F N, Kedlaya P G. Social Impact of End-Stage Renal Disease Requiring Hemodialysis among Patients with Type-2 Diabetes and Their Caregivers in Bengaluru, Karnataka[J]. Indian J Community Med, 2021,46(4):626–630. Culp S, Lupu D, Arenella C, et al. Unmet Supportive Care Needs in U.S. Dialysis Centers and Lack of Knowledge of Available Resources to Address Them[J]. J Pain Symptom Manage, 2016,51(4):756–761. Solesky B C, Huber T S, Berceli S A. Patient-centric analysis of dialysis access outcomes[J]. J Vasc Access, 2010,11(1):31–37. Radhakrishnan Y, Dasari J, Anvari E, et al. Tunneled femoral dialysis catheter: Practical pointers[J]. J Vasc Access, 2023,24(4):545–551. Morita T, Fujimoto K, Nanba M, et al. [Palliative care in Seirei Mikatahara General Hospital Department of Palliative and Supportive Care, Seirei Mikatahara General Hospital][J]. Nihon Rinsho, 2007,65(1):128–137. Scirocco E, Cellini F, Donati C M, et al. Improving the Integration between Palliative Radiotherapy and Supportive Care: A Narrative Review[J]. Curr Oncol, 2022,29(10):7932–7942. Krakowski I. [Supportive care for people affected by cancer: concept and management][J]. Rev Prat, 2006,56(18):1989–1996. Additional Declarations No competing interests reported. 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-7478622","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":538415371,"identity":"5a363951-17a1-4f42-9f3b-2c4e1903877d","order_by":0,"name":"Sijia Chen","email":"","orcid":"","institution":"The First People's Hospital of Changzhou","correspondingAuthor":false,"prefix":"","firstName":"Sijia","middleName":"","lastName":"Chen","suffix":""},{"id":538415372,"identity":"05efc553-98c2-4d4e-aa70-f07a76d79c60","order_by":1,"name":"Xiuming 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This demographic often faces a myriad of physical, emotional, and social challenges that significantly impact their quality of life. Supportive care needs, defined as the totality of assistance beyond medical treatment that patients require during their illness, have emerged as a critical area of focus in the management of chronic diseases, including ESRD [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. As the complexity of care continues to evolve, integrating supportive care into standard treatment protocols is essential to ensure that patients receive holistic and patient-centered care[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eDespite the recognition of the importance of supportive care, research into the specific needs of hemodialysis patients remains insufficient. A limited number of studies have systematically assessed the supportive care needs within this population, often focusing on technical aspects of dialysis and the management of complications rather than the broader psychosocial dimensions of care [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Furthermore, existing literature indicates that a significant proportion of hemodialysis patients experience unmet needs, particularly in areas related to emotional support, information, and financial assistance[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. A study highlighted that factors such as uncertainty, depression, and social support significantly influence self-care compliance among patients undergoing hemodialysis. The findings indicated that patients who experience higher levels of uncertainty tend to exhibit lower self-care compliance, underscoring the need for targeted interventions aimed at reducing uncertainty and enhancing self-care through education and accurate information dissemination[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].Moreover, Liu et al. (2022) explored the role of care partners in supporting the mobility of older adults on hemodialysis, revealing that these partners often witness a decline in mobility and provide essential support. This highlights the critical role of caregivers in the hemodialysis setting and suggests that interventions aimed at empowering care partners could improve patient outcomes[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Additionally, a qualitative study conducted by Ferreira da Silva et al. (2021) emphasized the necessity of improving information delivery in hemodialysis care, as inadequate communication can lead to confusion and decreased patient satisfaction[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].The need for holistic approaches to care is further evidenced by research focusing on the lived experiences of hemodialysis patients, which reveals that many face significant emotional and physical challenges. For instance, Alzahrani et al. (2023) found that patients often struggle with social isolation and fatigue, indicating a pressing need for comprehensive support systems that address both physical and emotional well-being[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].This gap in understanding highlights the necessity for targeted research that examines the unique challenges faced by this patient population and identifies the factors influencing their supportive care needs.\u003c/p\u003e\u003cp\u003e The methodology employed in this study utilizes a cross-sectional design, which is particularly advantageous for capturing a snapshot of the current state of supportive care needs among hemodialysis patients. A convenience sampling approach allows for the inclusion of a diverse cohort of patients from various backgrounds, thereby enhancing the generalizability of the findings. The use of validated assessment tools, such as the Supportive Care Needs Survey (SCNS), facilitates a comprehensive evaluation of patients\u0026rsquo; needs across multiple dimensions, including physical, psychological, and informational support [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. By employing robust statistical analyses, the study aims to elucidate the relationships between demographic, clinical, and psychosocial factors that may contribute to variations in supportive care needs.\u003c/p\u003e\u003cp\u003eThe objectives of this research are twofold: firstly, to systematically assess the current status of supportive care needs among hemodialysis patients, and secondly, to analyze the associated factors that may influence these needs. By achieving these objectives, the study seeks to provide a foundation for developing a more precise and individualized supportive care intervention framework, ultimately aiming to improve patient outcomes and enhance the quality of life for individuals undergoing hemodialysis. This research is anticipated to contribute valuable insights into the design of comprehensive care models that address not only the medical but also the psychosocial aspects of patient care, aligning with contemporary healthcare paradigms that emphasize patient-centered approaches[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStudy design and participants\u003c/h2\u003e\u003cp\u003eA cross-sectional study was conducted using a structured self-report questionnaire. The Strengthening the Reporting of Observation studies in Epidemiology (STROBE) checklist for cross-sectional studies was followed to ensure comprehensive reporting. Data collection took place at Changzhou First People's Hospital between December 2024 and March 2025. Participants were recruited via convenience sampling. Inclusion criteria were: (a) diagnosed with end-stage chronic kidney disease undergoing hemodialysis; (b) aged\u0026thinsp;\u0026ge;\u0026thinsp;18 years; (c) able to communicate effectively and comprehend questionnaires; and (d) provided informed consent. Exclusion criteria were: (a) patients requiring temporary hemodialysis for acute conditions (e.g., acute liver failure, refractory heart failure); (b) patients with severe comorbidities (e.g., malignancy, active severe infection); and (c) patients with diagnosed psychiatric disorders. The sample size was calculated using the formula proposed by Ni Ping[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e], which recommends 10\u0026ndash;20 times the number of items in the primary scale. The main instrument (Supportive Care Needs Survey, SCNS) contained 36 items. Accounting for a 10% invalid response rate, the required sample size ranged between 396 and 792. A target sample size of 550 was set to ensure adequate power.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eMeasurements\u003c/h3\u003e\n\u003cp\u003eThe questionnaire comprised three sections:\u003c/p\u003e\u003cp\u003eSociodemographic and Clinical Characteristics Sheet: Researcher-designed based on literature review[\u003cspan additionalcitationids=\"CR13 CR14 CR15 CR16 CR17 CR18 CR19 CR20 CR21 CR22 CR23\" citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e], collecting data on demographics (gender, age, residence, marital status, employment, education, income), disease characteristics (primary diagnosis, dialysis vintage, dialysis frequency), and psychosocial status.\u003c/p\u003e\u003cp\u003eSupportive Care Needs Survey (SCNS): A validated 36-item scale developed by Gai Tiantian[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e] specifically for hemodialysis patients. It assesses needs across seven domains: Physical (5 items), Psychological (5 items), Social (6 items), Emotional (5 items), Spiritual (4 items), Informational (7 items), and Practical (4 items). Items are rated on a 5-point Likert scale (1 = \"No need\" to 5 = \"High need\"). The scale demonstrated good internal consistency, with Cronbach's α coefficients for the domains ranging from 0.891 to 0.937 in previous validation .\u003c/p\u003e\u003cp\u003eKarnofsky Performance Status (KPS) Scale Score[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]: Assessed by the researcher. This scale evaluates functional status and dependency levels (score range: 0-100; 100\u0026thinsp;=\u0026thinsp;normal function, 0\u0026thinsp;=\u0026thinsp;death). Scores were categorized as: Dependent (\u0026le;\u0026thinsp;50), Semi-dependent (50\u0026ndash;70), or Independent (\u0026ge;\u0026thinsp;80).\u003c/p\u003e\n\u003ch3\u003eData Collection Procedure\u003c/h3\u003e\n\u003cp\u003eFollowing approval by the hospital ethics committee, potential participants were approached during their dialysis sessions. The study purpose, procedures, and significance were explained. Written informed consent was obtained from all participants. Trained research assistants administered the questionnaires. Participants self-completed the sociodemographic sheet and SCNS. For participants with visual or other impairments preventing self-completion but with intact cognition, the research assistant read the items aloud and recorded their responses. The KPS score was assessed by the researcher. Questionnaires were checked for completeness upon collection, with immediate clarification sought for missing items. Average completion time was 10\u0026ndash;15 minutes.\u003c/p\u003e\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\u003ch2\u003eStatistical Analysis\u003c/h2\u003e\u003cp\u003eData were entered into Excel and verified by two independent researchers. Statistical analyses were performed using SPSS version 25.0. Descriptive statistics were used: frequencies and percentages (%) for categorical variables; means and standard deviations (x̄\u0026plusmn;SD) for normally distributed continuous variables. Group differences in SCNS total score were analyzed using independent samples t-tests or one-way Analysis of Variance (ANOVA) for categorical independent variables with two or more than two groups, respectively. Variables showing statistically significant associations (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05) in univariate analyses were entered into a multiple linear regression model to identify independent predictors of supportive care needs. Statistical significance was set at P\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eEthical Considerations\u003c/h3\u003e\n\u003cp\u003e The study protocol was approved by the Ethics Committee of Changzhou First People's Hospital (statement number 2024(Research)CL109-01). All participants provided written informed consent after receiving detailed information about the study. Confidentiality was maintained throughout data handling and storage, with data disposed of according to institutional guidelines. Participants were informed of their right to withdraw at any time without consequence.\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e\u003ch2\u003eParticipant Characteristics\u003c/h2\u003e\u003cp\u003eA total of 550 questionnaires were distributed, with 502 valid responses collected, resulting in a response rate of 91.27%. The majority of participants were male (63.5%), with an average age of 56.63\u0026thinsp;\u0026plusmn;\u0026thinsp;13.505 years. The demographic and clinical characteristics of the participants are presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003e Demographic and Clinical Characteristics of Participants(n\u0026thinsp;=\u0026thinsp;502)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCategory\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003en\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cem\u003et\u003c/em\u003e/\u003cem\u003eF\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDialysis Vintage\u0026nbsp;(years)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e9.978\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026le;\u0026thinsp;1 year\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e86\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e123.67\u0026thinsp;\u0026plusmn;\u0026thinsp;34.14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2\u0026ndash;5 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e201\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e111.29\u0026thinsp;\u0026plusmn;\u0026thinsp;30.09\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e6\u0026ndash;10 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e92\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e100.87\u0026thinsp;\u0026plusmn;\u0026thinsp;28.22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;10 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e123\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e103.68\u0026thinsp;\u0026plusmn;\u0026thinsp;32.48\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMarital Status\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2.738\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.043\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMarried\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e400\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e110.93\u0026thinsp;\u0026plusmn;\u0026thinsp;31.74\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUnmarried\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e106.19\u0026thinsp;\u0026plusmn;\u0026thinsp;31.11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDivorced\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e109.56\u0026thinsp;\u0026plusmn;\u0026thinsp;33.23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWidowed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e91.14\u0026thinsp;\u0026plusmn;\u0026thinsp;29.67\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEducational Level\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2.676\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.031\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eElementary School\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e69\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e119.90\u0026thinsp;\u0026plusmn;\u0026thinsp;31.90\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMiddle School\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e162\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e105.20\u0026thinsp;\u0026plusmn;\u0026thinsp;30.34\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHigh School or Vocational\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e147\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e110.19\u0026thinsp;\u0026plusmn;\u0026thinsp;32.67\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCollege\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e67\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e107.87\u0026thinsp;\u0026plusmn;\u0026thinsp;28.89\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBachelor's Degree or Above\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e57\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e110.51\u0026thinsp;\u0026plusmn;\u0026thinsp;35.64\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePrimary Caregiver\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.446\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.640\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSpouse\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e303\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e110.57\u0026thinsp;\u0026plusmn;\u0026thinsp;31.77\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003echildren\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e92\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e107.01\u0026thinsp;\u0026plusmn;\u0026thinsp;33.47\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOther\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e107\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e109.27\u0026thinsp;\u0026plusmn;\u0026thinsp;31.09\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFamily Monthly Income (RMB)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.668\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.572\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026le;\u0026thinsp;1000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e114.89\u0026thinsp;\u0026plusmn;\u0026thinsp;34.81\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1001\u0026ndash;3000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e183\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e108.03\u0026thinsp;\u0026plusmn;\u0026thinsp;32.97\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3001\u0026ndash;5000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e161\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e108.94\u0026thinsp;\u0026plusmn;\u0026thinsp;29.87\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026gt;5000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e113\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e111.14\u0026thinsp;\u0026plusmn;\u0026thinsp;31.94\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eInsurance Type\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2.399\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.049\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSelf-Pay\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e106.00\u0026thinsp;\u0026plusmn;\u0026thinsp;28.42\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEmployee Insurance\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e382\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e107.39\u0026thinsp;\u0026plusmn;\u0026thinsp;32.16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eResident Insurance\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e72\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e117.67\u0026thinsp;\u0026plusmn;\u0026thinsp;28.83\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNew Rural Cooperative\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e34\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e119.00\u0026thinsp;\u0026plusmn;\u0026thinsp;35.25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOther\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e108.00\u0026thinsp;\u0026plusmn;\u0026thinsp;16.61\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEconomic Burden\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e5.261\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLow\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e46\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e97.85\u0026thinsp;\u0026plusmn;\u0026thinsp;29.38\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eModerate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e273\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e107.71\u0026thinsp;\u0026plusmn;\u0026thinsp;30.39\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHigh\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e148\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e113.88\u0026thinsp;\u0026plusmn;\u0026thinsp;32.17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVery High\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e122.29\u0026thinsp;\u0026plusmn;\u0026thinsp;39.29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDialysis Frequency\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e3.792\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.010\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2 times/week\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e39\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e108.49\u0026thinsp;\u0026plusmn;\u0026thinsp;31.30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3 times/week\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e440\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e108.99\u0026thinsp;\u0026plusmn;\u0026thinsp;31.77\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;3 times/week\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e117.65\u0026thinsp;\u0026plusmn;\u0026thinsp;31.27\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOther\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e167.00\u0026thinsp;\u0026plusmn;\u0026thinsp;4.36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDialysis Access Type\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e8.116\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.000\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003earteriovenous fistula\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e415\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e107.15\u0026thinsp;\u0026plusmn;\u0026thinsp;31.12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003egraft arteriovenous fistula\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e114.17\u0026thinsp;\u0026plusmn;\u0026thinsp;31.72\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCatheter\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e69\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e123.43\u0026thinsp;\u0026plusmn;\u0026thinsp;33.44\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePrimary Disease\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e3.527\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.004\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGlomerulonephritis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e102\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e102.46\u0026thinsp;\u0026plusmn;\u0026thinsp;34.10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDiabetic Nephropathy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e114\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e118.51\u0026thinsp;\u0026plusmn;\u0026thinsp;33.23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHypertensive Nephropathy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e156\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e109.12\u0026thinsp;\u0026plusmn;\u0026thinsp;30.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSystemic Lupus Erythematosus\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e129.40\u0026thinsp;\u0026plusmn;\u0026thinsp;31.13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePolycystic Kidney Disease\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e34\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e110.82\u0026thinsp;\u0026plusmn;\u0026thinsp;31.65\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOther\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e91\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e105.93\u0026thinsp;\u0026plusmn;\u0026thinsp;28.69\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eComorbidities\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.812\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.125\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNone\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e90\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e107.32\u0026thinsp;\u0026plusmn;\u0026thinsp;30.62\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e218\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e107.39\u0026thinsp;\u0026plusmn;\u0026thinsp;32.72\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e128\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e110.38\u0026thinsp;\u0026plusmn;\u0026thinsp;31.43\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e118.10\u0026thinsp;\u0026plusmn;\u0026thinsp;35.04\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026ge;\u0026thinsp;4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e120.28\u0026thinsp;\u0026plusmn;\u0026thinsp;23.99\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGender\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.183\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.237\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e319\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e110.92\u0026thinsp;\u0026plusmn;\u0026thinsp;31.96\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e183\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e107.42\u0026thinsp;\u0026plusmn;\u0026thinsp;31.80\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eResidence\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e-0.174\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.862\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRural\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e119\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e109.19\u0026thinsp;\u0026plusmn;\u0026thinsp;34.72\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUrban\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e383\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e109.78\u0026thinsp;\u0026plusmn;\u0026thinsp;31.04\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEmployment Status\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e-0.523\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.601\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEmployed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e88\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e108.02\u0026thinsp;\u0026plusmn;\u0026thinsp;31.13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUnemployed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e414\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e109.98\u0026thinsp;\u0026plusmn;\u0026thinsp;32.10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eKPS Score\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e6.920\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDependent (\u0026lt;\u0026thinsp;50)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e34\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e124.00\u0026thinsp;\u0026plusmn;\u0026thinsp;34.27\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSemi-Independent (50\u0026ndash;70)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e172\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e113.39\u0026thinsp;\u0026plusmn;\u0026thinsp;30.98\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIndependent (\u0026ge;\u0026thinsp;80)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e296\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e105.81\u0026thinsp;\u0026plusmn;\u0026thinsp;31.55\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge (years)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.847\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.119\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e18\u0026ndash;44\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e104\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e107.82\u0026thinsp;\u0026plusmn;\u0026thinsp;31.61\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e45\u0026ndash;59\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e194\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e112.11\u0026thinsp;\u0026plusmn;\u0026thinsp;30.04\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e60\u0026ndash;74\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e149\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e111.11\u0026thinsp;\u0026plusmn;\u0026thinsp;34.75\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e75\u0026ndash;89\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e53\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e99.58\u0026thinsp;\u0026plusmn;\u0026thinsp;29.61\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026ge;\u0026thinsp;90\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e121.00\u0026thinsp;\u0026plusmn;\u0026thinsp;36.77\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003e Supportive Care Needs Scores of Hemodialysis Patients (n\u0026thinsp;=\u0026thinsp;502)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDimension\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eItems\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMinimum\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMaximum\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eTotal Score\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eItem Score\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eRanking\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal Score\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e180\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e109.64\u0026thinsp;\u0026plusmn;\u0026thinsp;31.92\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e\u003cp\u003e3.05\u0026thinsp;\u0026plusmn;\u0026thinsp;0.89\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePhysiological Needs\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e16.20\u0026thinsp;\u0026plusmn;\u0026thinsp;4.81\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e\u003cp\u003e3.24\u0026thinsp;\u0026plusmn;\u0026thinsp;0.96\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePsychological Needs\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e14.51\u0026thinsp;\u0026plusmn;\u0026thinsp;5.63\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e\u003cp\u003e2.90\u0026thinsp;\u0026plusmn;\u0026thinsp;1.13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSocial Needs\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e16.17\u0026thinsp;\u0026plusmn;\u0026thinsp;6.33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e\u003cp\u003e2.70\u0026thinsp;\u0026plusmn;\u0026thinsp;1.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEmotional Needs\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e13.93\u0026thinsp;\u0026plusmn;\u0026thinsp;5.59\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e\u003cp\u003e2.79\u0026thinsp;\u0026plusmn;\u0026thinsp;1.12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSpiritual Needs\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e11.65\u0026thinsp;\u0026plusmn;\u0026thinsp;4.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e\u003cp\u003e2.91\u0026thinsp;\u0026plusmn;\u0026thinsp;1.01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eInformation Needs\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e23.08\u0026thinsp;\u0026plusmn;\u0026thinsp;6.96\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e\u003cp\u003e3.30\u0026thinsp;\u0026plusmn;\u0026thinsp;0.99\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePractical Needs\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e14.10\u0026thinsp;\u0026plusmn;\u0026thinsp;3.84\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e\u003cp\u003e3.53\u0026thinsp;\u0026plusmn;\u0026thinsp;0.96\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003e Top 10 Supportive Care Needs Items of Hemodialysis Patients (n\u0026thinsp;=\u0026thinsp;502)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eItem\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eItem Score\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eDimension\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eG4 Help me reduce medical expenses and alleviate economic burden\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e3.63\u0026thinsp;\u0026plusmn;\u0026thinsp;1.16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePractical Needs\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eG2 Ensure the hemodialysis process is safe and effective, with timely response to machine alarms\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e3.56\u0026thinsp;\u0026plusmn;\u0026thinsp;1.09\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePractical Needs\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eA3 Provide a scientific and reasonable medication regimen\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e3.52\u0026thinsp;\u0026plusmn;\u0026thinsp;1.08\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePhysiological Needs\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eF5 Offer guidance on symptom control and complication prevention\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e3.49\u0026thinsp;\u0026plusmn;\u0026thinsp;1.09\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eInformation Needs\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eG3 Provide support to my family if they need help in managing my illness\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e3.47\u0026thinsp;\u0026plusmn;\u0026thinsp;1.08\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePractical Needs\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eG1 Create a quiet and comfortable treatment environment for me\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e3.45\u0026thinsp;\u0026plusmn;\u0026thinsp;1.15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePractical Needs\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eF6 Educate me on the protection of vascular access (e.g., arteriovenous fistula or catheter)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e3.44\u0026thinsp;\u0026plusmn;\u0026thinsp;1.13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eInformation Needs\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eE2 Seek my opinion before conducting related examinations or treatments\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e3.41\u0026thinsp;\u0026plusmn;\u0026thinsp;1.12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSpiritual Needs\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eA5 Assist me in controlling primary diseases and slowing disease progression\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e3.38\u0026thinsp;\u0026plusmn;\u0026thinsp;1.16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePhysiological Needs\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eF2 Explain the purpose and significance of the examinations or treatments I need\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e3.37\u0026thinsp;\u0026plusmn;\u0026thinsp;1.10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eInformation Needs\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eSupportive Care Needs of Hemodialysis Patients\u003c/h3\u003e\n\u003cp\u003eThe total score of supportive care needs for hemodialysis patients was 109.64\u0026thinsp;\u0026plusmn;\u0026thinsp;31.92, with an item mean score of 3.05\u0026thinsp;\u0026plusmn;\u0026thinsp;0.89, indicating a moderate to high level of need. Among the seven dimensions of needs, the highest item mean scores were observed in the dimensions of practical needs (3.53\u0026thinsp;\u0026plusmn;\u0026thinsp;0.96) and informational needs (3.30\u0026thinsp;\u0026plusmn;\u0026thinsp;0.99). The lowest item mean score was found in the social needs dimension (2.70\u0026thinsp;\u0026plusmn;\u0026thinsp;1.05). The top ten items with the highest mean scores are listed in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003eUnivariate Analysis of Supportive Care Needs\u003c/h2\u003e\u003cp\u003eUnivariate analysis revealed that factors such as dialysis duration, marital status, educational level, medical insurance type, economic burden, dialysis frequency, dialysis access type, primary disease, and KPS score significantly influenced the supportive care needs of hemodialysis patients (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Patients with a shorter dialysis duration (\u0026le;\u0026thinsp;1 year) had higher need scores than those with longer dialysis durations. Patients who were widowed had significantly lower need scores than those who were married. Patients with lower educational levels reported higher need scores. Patients with medical insurance types such as residents' medical insurance and new rural cooperative medical schemes had higher need scores. Patients experiencing a greater economic burden reported higher need scores. Patients with dialysis frequencies exceeding three times per week had higher need scores. Patients using dialysis catheters had higher need scores than those with arteriovenous fistulas. Patients with diabetic nephropathy as the primary disease had higher need scores. Patients with lower KPS scores had higher need scores.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003eMultivariate Linear Regression Analysis\u003c/h2\u003e\u003cp\u003eMultivariate linear regression analysis was performed with the total supportive care needs score as the dependent variable and the factors with statistical significance in the univariate analysis as independent variables. The results indicated that marital status, economic pressure, dialysis access type, primary disease, and dialysis duration were the main factors influencing the supportive care needs of hemodialysis patients. Economic pressure had the strongest impact, with patients experiencing very high economic pressure having a significantly higher needs score than those with lower economic pressure. Patients who were widowed had a significantly lower needs score than those who were married. Patients using dialysis catheters had a higher needs score than those with arteriovenous fistulas. Patients with diabetic nephropathy as the primary disease had a significantly higher needs score than those with other primary diseases. Patients with a dialysis duration of 6\u0026ndash;10 years had a significantly lower needs score than those with a shorter dialysis duration. The regression model explained 17.7% of the variance in supportive care needs scores.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003e Variables and Dummy Variable Coding for Multivariate Linear Regression Analysis (n\u0026thinsp;=\u0026thinsp;502)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCategory\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eDummy Coding\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDialysis Vintage\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026le;\u0026thinsp;1 year\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2\u0026ndash;5 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6\u0026ndash;10 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;10 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMarital Status\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMarried\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUnmarried\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDivorced\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eWidowed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEducational Level\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eElementary School\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMiddle School\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHigh School or Vocational\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCollege\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBachelor\u0026rsquo;s Degree or Above\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eInsurance Type\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSelf-Pay\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEmployee Insurance\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eResident Insurance\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNew Rural Cooperative\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOther\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEconomic Burden\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLow\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eModerate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHigh\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eVery High\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDialysis Frequency\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2 times/week\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3 times/week\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;3 times/week\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOther\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDialysis Access Type\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNative Arteriovenous Fistula\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGraft Arteriovenous Fistula\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCatheter\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePrimary Disease\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGlomerulonephritis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDiabetic Nephropathy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHypertensive Nephropathy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSystemic Lupus Erythematosus\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePolycystic Kidney Disease\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOther\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eKPS Score\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDependent (\u0026lt;\u0026thinsp;50)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSemi-Independent (50\u0026ndash;70)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIndependent (\u0026ge;\u0026thinsp;80)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003e Multiple Linear Regression Analysis of Factors Influencing Supportive Care Needs in Hemodialysis Patients (n\u0026thinsp;=\u0026thinsp;502)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cem\u003eB\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cem\u003eSE\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cem\u003eβ\u003c/em\u003e\u0026prime;\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003et\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eConstant\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e112.085\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e15.064\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e7.441\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMarital Status\u003c/p\u003e\u003cp\u003e(Widowed vs. Married)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-25.37\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6.885\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-0.159\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-3.685\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEconomic Pressure\u003c/p\u003e\u003cp\u003e(High vs. Low)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e13.892\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5.313\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.199\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.615\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.009\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEconomic Pressure\u003c/p\u003e\u003cp\u003e(Very High vs. Low)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e20.49\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7.071\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.164\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.898\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.004\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDialysis Access Type (Catheter vs. Native AV Fistula)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e8.663\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4.141\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.094\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.092\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.037\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePrimary Disease (Diabetic Nephropathy vs. Glomerulonephritis)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e12.154\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4.359\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.788\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.006\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDialysis Vintage\u003c/p\u003e\u003cp\u003e(6\u0026ndash;10 years vs. \u0026le;1 year)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-18.157\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4.722\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-0.22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-3.845\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDialysis Vintage\u003c/p\u003e\u003cp\u003e(\u0026gt;\u0026thinsp;10 years vs. \u0026le;1 year)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-14.836\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4.621\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-0.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-3.21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e\u003cp\u003e\u003cem\u003eNote: AV\u0026thinsp;=\u0026thinsp;Arteriovenous. R\u0026sup2; = 0.177, Adjusted R\u0026sup2; = 0.127, F\u0026thinsp;=\u0026thinsp;3.508, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001.\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe prevalence of end-stage renal disease (ESRD) continues to rise globally, posing significant health challenges for affected individuals. Hemodialysis, a common treatment modality for ESRD, often leads to various physical, emotional, and social burdens due to the chronic nature of the disease. Patients frequently experience a high symptom burden, economic stress, and disruptions in their daily lives, which can significantly affect their overall quality of life. Moreover, as the demographic profile of patients with ESRD evolves, with an increasing number of elderly and co-morbid patients, the complexity of their care needs has become more pronounced. Research indicates that unmet supportive care needs are prevalent in this population, highlighting the critical need for integrated palliative and supportive care approaches tailored to individual patient circumstances and preferences[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThis study aims to systematically assess the supportive care needs of patients undergoing hemodialysis and identify the factors influencing these needs. By employing a cross-sectional design, we surveyed 550 patients at a local hospital, gathering data on demographics, clinical characteristics, and supportive care needs using validated instruments. Our findings reveal that hemodialysis patients express moderate to high levels of supportive care needs, with particular emphasis on practical and informational support. Furthermore, various demographic and clinical factors, such as economic burden, marital status, dialysis access type, primary disease, and dialysis vintage, significantly influence the extent of these needs. The following discussion will delve into the implications of these findings for designing targeted interventions to enhance the quality of care and overall well-being of patients receiving hemodialysis[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThis study revealed that the total score for supportive care needs among hemodialysis patients was 109.64\u0026thinsp;\u0026plusmn;\u0026thinsp;31.92 (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e), indicating a moderately high level of need. This finding is consistent with similar domestic studies [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Analysis of domain scores identified practical needs and informational needs as the top two priorities. Notably, \u0026ldquo;reducing medical costs\u0026rdquo;and \u0026ldquo;ensuring hemodialysis procedure safety\u0026rdquo; represented particularly urgent demands, reflecting the core significance of economic pressure and treatment safety for this population. Although psychological/spiritual needs scored lower overall, the specific item \u0026ldquo;soliciting patient opinions before relevant tests/treatments\u0026rdquo;still ranked within the top eight. This suggests a potential latent need for greater participation in medical decision-making that may not be fully addressed.Compared to prior research, a key innovation of this study lies in establishing the priority ranking of specific needs through item analysis. For instance, items related to economic burden (G4, G2) occupied the top two positions, while items concerning psychological support did not rank within the top ten. This result challenges the conventional view that psychological intervention is a core need for dialysis patients. A plausible explanation is that within a resource-constrained healthcare environment, patients prioritize addressing\u0026ldquo;survival-driven needs\u0026rdquo; (such as cost and treatment safety) that have a direct and immediate impact on their survival. Psychological concerns may be temporarily suppressed or attributed to external circumstances under these pressures.\u003c/p\u003e\u003cp\u003eThe strong association between economic burden and higher supportive care needs (β\u0026thinsp;=\u0026thinsp;0.199 for high burden, β\u0026thinsp;=\u0026thinsp;0.164 for very high burden) underscores the profound impact of financial stress on patients\u0026rsquo; well-being. Both univariate and multivariate analyses identified economic pressure as the strongest predictor of elevated supportive care needs. Patients reporting a \u0026ldquo;very high\u0026rdquo; economic burden had a significantly higher needs score of 122.29\u0026thinsp;\u0026plusmn;\u0026thinsp;39.29 compared to other groups (P\u0026thinsp;=\u0026thinsp;0.001). This resonates with global studies highlighting that out-of-pocket costs for dialysis, medications, and transportation exacerbate psychological distress and reduce treatment adherence[\u003cspan additionalcitationids=\"CR30 CR31\" citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. Furthermore, within the multivariate model, patients experiencing \u0026ldquo;high\u0026rdquo; and \u0026ldquo;very high\u0026rdquo; economic pressure demonstrated total needs scores 13.9 times and 20.5 times higher, respectively, than those with \"low\" economic pressure (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). This study further elucidates the dual pathways through which economic pressure impacts needs: Directly increasing practical needs: Primarily manifested as demands for reduced medical costs. Indirectly exacerbating psychological burden: Such as anxiety related to medical debt. Notably, the influence of health insurance type in China presents unique characteristics. Patients enrolled in Urban Resident Basic Medical Insurance (URBMI) and the New Rural Cooperative Medical Scheme (NCMS) exhibited significantly higher needs scores than those covered by Urban Employee Basic Medical Insurance (UEBMI). This disparity is likely attributable to differences in reimbursement rates and scope of coverage between these insurance schemes. Optimizing the tiered design of health insurance coverage and implementing targeted subsidies for low-income and rural patients emerge as crucial strategies for addressing this issue.\u003c/p\u003e\u003cp\u003ePatients with diabetic nephropathy (DN) as their primary kidney disease demonstrated significantly higher total supportive care needs scores (118.51\u0026thinsp;\u0026plusmn;\u0026thinsp;33.23) compared to groups with other primary diseases (P\u0026thinsp;=\u0026thinsp;0.006). Multivariate analysis further confirmed its independent effect as a risk factor (β\u0026thinsp;=\u0026thinsp;12.15). Potential mechanisms underlying this elevated need include: Diabetes mellitus acts as the primary disease that induces nephropathy, which in turn drives multisystem complications, ultimately forming a bidirectional vicious cycle[\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]; Increased Multisystem Involvement: DN is frequently complicated by multisystem damage, such as cardiovascular disease and neuropathy, leading to greater overall treatment complexity. Managing both diabetes-related parameters (e.g., blood glucose, hypertension) and dialysis-specific protocols creates a dual care burden, substantially intensifying self-management requirements[\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e].Furthermore, patients with systemic lupus erythematosus (SLE) exhibited notably high needs scores (129.40\u0026thinsp;\u0026plusmn;\u0026thinsp;31.13). However, due to the limited sample size in this subgroup (n\u0026thinsp;=\u0026thinsp;5), these findings must be interpreted with caution. Future research should aim to enroll larger samples of patients with less common primary kidney diseases to validate the existence and nature of any disease-specific needs profiles.\u003c/p\u003e\u003cp\u003ePatients' supportive care needs exhibit dynamic changes as dialysis duration increases. Patients with a dialysis vintage of \u0026le;\u0026thinsp;1 year had the highest total need score (123.67\u0026thinsp;\u0026plusmn;\u0026thinsp;34.14), while the 6\u0026ndash;10 years group scored the lowest (100.87\u0026thinsp;\u0026plusmn;\u0026thinsp;28.22). Multivariate modeling revealed a significant negative association between the needs score of the 6\u0026ndash;10 year dialysis vintage group and the \u0026le;\u0026thinsp;1 year reference group (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Patients in the initial phase require substantial support for disease knowledge acquisition, skill development, and psychological adaptation [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. As treatment duration extends, patients may experience reduced needs through adaptation to the disease and the establishment of support networks. However, the needs of the \u0026gt;\u0026thinsp;10 years dialysis vintage group showed a slight increase (103.68\u0026thinsp;\u0026plusmn;\u0026thinsp;32.48), potentially related to the accumulation of long-term complications and \"treatment fatigue.\" This finding supports the \"dynamic needs model,\" indicating that patient needs do not decline linearly but fluctuate throughout the disease course. In clinical practice, interventions should be tailored according to the patient's dialysis stage. Leveraging the Information-Motivation-Behavioral Skills (IMB) model can continuously enhance self-management capabilities, while establishing a nurse-led \"hub-and-satellite\" collaborative network facilitates resource sharing. Regarding intervention timing, early-stage efforts should intensify patient education, the mid-stage should focus on psychosocial adaptation, and the late-stage should prioritize symptom control and advance care planning. Cultural adaptation tools should be employed concurrently to reduce decision-making disparities.\u003c/p\u003e\u003cp\u003eDespite the relatively low mean score in the social needs domain (2.70\u0026thinsp;\u0026plusmn;\u0026thinsp;1.05), a counterintuitive finding emerged: widowed patients demonstrated significantly lower total supportive care needs scores compared to their married counterparts (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). This paradoxical observation may arise from two potential mechanisms related to disrupted social support networks: Widowed patients may underreport actual needs due to reluctance to seek assistance stemming from perceived stigma or self-reliance. Latent psychosocial needs may be displaced and expressed as heightened demands in other domains, most notably practical care requirements. Furthermore, the primary caregiver's relationship to the patient (spouse vs. adult child) did not significantly predict needs scores. This null finding likely reflects culturally embedded caregiving dynamics within Chinese familial structures. Patients receiving care from either spouses or children demonstrated consistent suppression of need expression\u0026mdash;potentially to preserve familial harmony or avoid perceptions of being burdensome within intergenerational relationships.\u003c/p\u003e\u003cp\u003eThe use of catheters (compared to arteriovenous fistulas) is associated with increased needs (β\u0026thinsp;=\u0026thinsp;0.094, p\u0026thinsp;=\u0026thinsp;0.037). Physiologically, the catheter, as a foreign body, continuously irritates the vascular wall, triggering the release of inflammatory cytokines which exacerbate symptoms like fatigue and pain. Psychosocially, the visible catheter segment impacts body image, and restrictions on activities such as bathing impair social participation. Study [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]revealed that catheter users experience infection and thrombosis complication rates as high as 1.3 episodes per year, necessitating frequent hospital visits, antibiotic therapy, and catheter replacements. Patients with femoral vein catheters face an even higher catheter-related infection rate of 27%, increasing emergency department visits and hospitalization demands. Inadequate catheter flow leads to inadequate dialysis and necessitates frequent imaging assessments. Bathing restrictions and the exposed catheter requiring specialized waterproof devices (e.g., catheter protective sleeves) contribute to reduced self-care capacity [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. Consequently, the higher risk of complications and restricted mobility directly elevate the need for medical interventions, daily living assistance, psychosocial support, and financial aid.\u003c/p\u003e\u003cp\u003ewhile earlier works have documented the physical and psychological challenges faced by these patients, they often overlooked the nuanced understanding of their support needs, particularly in economic and informational aspects, which emerged as critical factors in our study[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. The prominence of practical needs (e.g., reducing medical costs, ensuring treatment safety) and informational needs (e.g., symptom control guidance, vascular access education) as top priorities echoes Ferreira da Silva et al.\u0026rsquo;s emphasis on communication gaps in hemodialysis care [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e] and Liu et al.\u0026rsquo;s call for enhanced patient education [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. This reinforces the necessity of shifting from disease-centered to holistic, patient-centered care models that address socioeconomic and informational vulnerabilities [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe implications of our findings extend beyond the individual patient level, influencing clinical practice and health policy. The identification of economic burden as a significant predictor of supportive care needs suggests that healthcare systems must prioritize the integration of financial assistance into the care continuum for hemodialysis patients. This could include developing targeted strategies to alleviate financial strain, such as enhancing access to social services or adjusting insurance coverage policies. Furthermore, the recognition of specific needs related to various primary diseases indicates that personalized care plans should be developed, focusing not only on the medical management of renal disease but also on the holistic well-being of patients[\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. Such a comprehensive approach could enhance treatment adherence and overall patient quality of life, thereby potentially improving clinical outcomes.\u003c/p\u003e\u003cp\u003eHowever, this study is not without its limitations, which must be acknowledged to contextualize our findings accurately. The cross-sectional design inherently restricts our ability to assess the dynamic changes in supportive care needs over time. Additionally, the convenience sampling method may limit the generalizability of our results to the broader hemodialysis population. Future longitudinal studies are warranted to explore how supportive care needs evolve throughout the treatment journey and how these changes correlate with patient outcomes[\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]. Addressing these limitations in subsequent research will provide a more comprehensive understanding of the factors influencing supportive care needs and inform the development of more effective interventions tailored to individual patient profiles.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn conclusion, this study highlights that the supportive care needs of hemodialysis patients are generally at a moderately high level, with particular emphasis on practical and informational needs. The findings underscore the necessity for a tailored, phase-specific intervention framework that addresses the unique challenges faced by patients at various stages of treatment. By prioritizing economic assistance and treatment guidance for newly initiated dialysis patients, and focusing on complications prevention and psychological support for long-term patients, healthcare providers can enhance patient quality of life and adherence to treatment regimens. Ultimately, a shift from a purely disease management approach to one that encompasses holistic care is essential for improving the overall well-being of hemodialysis patients.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eFunding\u003c/h2\u003e\u003cp\u003eThis research was funded by grants from research fund of Changzhou First People's Hospital (No: yy2023015).\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eXM.Z. oversaw and directed the study. SJ.C. and XM.Z. authored the manuscript. SJ.C. and XY. Z. executed the data collection protocol. HY.N interpreted the data, conducted statistical analysis. All authors approved the final manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgements\u003c/h2\u003e\u003cp\u003eThe authors express gratitude to patients participating in the survey.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe datasets used and analyzed during the current study are available from the corresponding author upon reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003ePhipps L, Walker R (2013) Educational Needs in Supportive and End of Life Care. Nephrology (Carlton), 2013. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1111/nep.12087\u003c/span\u003e\u003cspan address=\"10.1111/nep.12087\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHowell D (2011) Palliative care research: urgent need for investment. 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Tianjin University of Traditional Chinese Medicine, Tianjin, China.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLu XH, Yao JP, Wei J, et al. Investigation of nursing needs in induction-phase hemodialysis patients[J].Chinese Journal of Nursing, 2004(9):68\u0026ndash;70. Chinese.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBrown E A, Zhao J, McCullough K, et al. Burden of Kidney Disease, Health-Related Quality of Life, and Employment Among Patients Receiving Peritoneal Dialysis and In-Center Hemodialysis: Findings From the DOPPS Program[J]. Am J Kidney Dis, 2021,78(4):489\u0026ndash;500.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eXhulia D, Gerta J, Dajana Z, et al. Needs of Hemodialysis Patients and Factors Affecting Them[J]. Glob J Health Sci, 2015,8(6):109\u0026ndash;120.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eShih C, Huang C, Huang M, et al. The association of sociodemographic factors and needs of haemodialysis patients according to Maslow's hierarchy of needs[J]. J Clin Nurs, 2019,28(1\u0026ndash;2):270\u0026ndash;278.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGuti\u0026eacute;rrez S\u0026aacute;nchez D, Leiva-Santos J P, Cuesta-Vargas A I. Symptom Burden Clustering in Chronic Kidney Disease Stage 5[J]. Clin Nurs Res, 2019,28(5):583\u0026ndash;601.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLe Leu R, Bennett P N, Dansie K, et al. Changes in symptom burden in the first 6 months after dialysis commencement: a prospective longitudinal observational cohort study[J]. J Nephrol, 2023,36(5):1485\u0026ndash;1488.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLee K, Song H C, Choi E J, et al. Posttraumatic Embitterment Disorder in Patients with Chronic Kidney Disease[J]. Clin Psychopharmacol Neurosci, 2019,17(2):183\u0026ndash;188.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eOberoi D, White V M, Seymour J F, et al. The influence of unmet supportive care needs on anxiety and depression during cancer treatment and beyond: a longitudinal study of survivors of haematological cancers[J]. Support Care Cancer, 2017,25(11):3447\u0026ndash;3456.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWang X, Shi Q, Mo Y, et al. Palliative care needs and symptom burden in younger and older patients with end-stage renal disease undergoing maintenance hemodialysis: A cross-sectional study[J]. Int J Nurs Sci, 2022,9(4):422\u0026ndash;429.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLiu Min, Zhang Lu, Sun Lihua, et al. Analysis of KPS Score Status of Chemotherapy Patients in Liaoning Province [J]. China Cancer, 2013, 22(8): 635\u0026ndash;637.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGelfand S L, Scherer J S, Koncicki H M. Kidney Supportive Care: Core Curriculum 2020[J]. Am J Kidney Dis, 2020,75(5):793\u0026ndash;806.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBerzoff J, Swantkowski J, Cohen L M. Developing a renal supportive care team from the voices of patients, families, and palliative care staff[J]. Palliat Support Care, 2008,6(2):133\u0026ndash;139.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLloyd-Williams M, Abba K, Crowther J. Supportive and palliative care for patients with chronic mental illness including dementia[J]. Curr Opin Support Palliat Care, 2014,8(3):303\u0026ndash;307.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLiu X, Mao Y, Wang H, et al. Path Analysis on Medical Expenditures of 855 Patients with Chronic Kidney Disease in a Hospital in Beijing[J]. Chin Med J (Engl), 2018,131(1):25\u0026ndash;31.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBaghdadi L R, Alsaiady M M. Medication Adherence Barriers and Their Relationship to Health Determinants for Saudi Pediatric Dialysis Patients[J]. Children (Basel), 2024,11(3).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eOmranikhoo H, Shabani S, Esfandiari A, et al. Economic burden of end stage renal disease: a case study in southern Iran[J]. Health Econ Rev, 2025,15(1):51.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKassa D A, Mekonnen S, Kebede A, et al. Cost of Hemodialysis Treatment and Associated Factors Among End-Stage Renal Disease Patients at the Tertiary Hospitals of Addis Ababa City and Amhara Region, Ethiopia[J]. Clinicoecon Outcomes Res, 2020,12:399\u0026ndash;409.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRen X, Kang N, Yu X, et al. 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J Vasc Access, 2010,11(1):31\u0026ndash;37.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRadhakrishnan Y, Dasari J, Anvari E, et al. Tunneled femoral dialysis catheter: Practical pointers[J]. J Vasc Access, 2023,24(4):545\u0026ndash;551.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMorita T, Fujimoto K, Nanba M, et al. [Palliative care in Seirei Mikatahara General Hospital Department of Palliative and Supportive Care, Seirei Mikatahara General Hospital][J]. Nihon Rinsho, 2007,65(1):128\u0026ndash;137.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eScirocco E, Cellini F, Donati C M, et al. Improving the Integration between Palliative Radiotherapy and Supportive Care: A Narrative Review[J]. Curr Oncol, 2022,29(10):7932\u0026ndash;7942.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKrakowski I. [Supportive care for people affected by cancer: concept and management][J]. Rev Prat, 2006,56(18):1989\u0026ndash;1996.\u003c/span\u003e\u003c/li\u003e\u003c/ol\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, hemodialysis, Supportive care needs","lastPublishedDoi":"10.21203/rs.3.rs-7478622/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7478622/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eEnd-stage renal disease (ESRD) presents significant challenges for patients undergoing hemodialysis, characterized by high morbidity and complex care needs. This study aimed to systematically assess the supportive care needs of hemodialysis patients and analyze the associated influencing factors to provide a scientific basis for developing a precise nursing intervention system aimed at improving long-term prognosis and quality of life.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eA total of 550 hemodialysis patients were recruited from the First People\u0026rsquo;s Hospital of Changzhou from December 2024 to March 2025, with 502 valid questionnaires collected using a convenience sampling method. The research utilized a demographic questionnaire, the Supportive Care Needs Survey (SCNS), and the Karnofsky Performance Scale (KPS) for data collection. Statistical analysis was performed using SPSS 25.0, with a focus on descriptive statistics, one-way ANOVA, independent samples t-tests, and multiple linear regression to identify factors impacting supportive care needs.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003e The results indicated that the overall supportive care needs score was 109.64\u0026thinsp;\u0026plusmn;\u0026thinsp;31.92, reflecting a moderately high level, with significant needs identified in practical support and information-related areas. Factors such as marital status, economic burden, access route type, primary disease, and duration of dialysis significantly influenced these needs.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003eThe study concludes that hemodialysis patients exhibit a moderate to high level of supportive care needs, particularly regarding practical and informational demands. Future clinical practice should focus on constructing a phased precision intervention system that targets distinct stages of dialysis, emphasizing economic assistance, treatment guidance, and comprehensive support to transition from \u0026ldquo;disease management\u0026rdquo; to \u0026ldquo;holistic care,\u0026rdquo; thereby enhancing patient quality of life and treatment adherence. Further longitudinal studies are warranted to explore the dynamic changes in supportive care needs over time.\u003c/p\u003e","manuscriptTitle":"Supportive Care Needs and Associated Factors in Hemodialysis Patients: A Cross-Sectional Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-11-03 08:27:17","doi":"10.21203/rs.3.rs-7478622/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":"768fe54e-c766-41c4-ae5d-4434588cc4ec","owner":[],"postedDate":"November 3rd, 2025","published":true,"recentEditorialEvents":[{"type":"editorInvitedReview","content":"","date":"2026-05-15T19:34:41+00:00","index":12,"fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-11-03T08:27:18+00:00","versionOfRecord":[],"versionCreatedAt":"2025-11-03 08:27:17","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7478622","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7478622","identity":"rs-7478622","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}