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

## TL;DR

This study in southern Iran found that hemodialysis patients have poor quality of life, influenced by education, insurance, and lifestyle factors.

## Contribution

The study identifies socioeconomic and lifestyle factors as key determinants of health-related quality of life in hemodialysis patients in southern Iran.

## Key findings

- Higher education levels were significantly associated with better HRQoL scores.
- Being divorced/widowed or retired/disabled was linked to reduced quality of life scores.
- Smoking and lack of insurance were associated with lower mental and physical health scores.

## Abstract

Hemodialysis (HD) is a common treatment for end-stage renal disease (ESRD) but is often accompanied by markedly reduced health-related quality of life (HRQoL). This study aimed to assess HRQoL and its determinants among HD patients.

In this cross-sectional study, 203 adult HD patients in Bandar Abbas, Iran, were evaluated. HRQoL was measured via the EQ-5D-5 L index, EQ-VAS, and SF-12 physical (PCS) and mental (MCS) component summary scores. Multivariable linear regression models, identified factors significantly associated with HRQoL.

The mean (SD) EQ-5D-5 L index, EQ-VAS, PCS, and MCS scores were 0.50 (0.47), 64.9 (23.7), 42.3 (8.1), and 42.3 (9.0), respectively. Individuals with higher levels of education demonstrated significantly better EQ-5D-5L index scores (β: 0.24, 95% CI: 0.06 to 0.41 for <6 classes; β: 0.22, 95% CI: 0.03 to 0.40 for 6–12 classes; β: 0.33, 95% CI: 0.13 to 0.52 for >12 years). Being divorced/widowed (β: −20.5, 95% CI: −35.7 to −5.3) or retired/disabled (β: −22.5, 95% CI: −41.6 to −3.3) showed a statistically significant association with reduced EQ-VAS scores. Having supplemental insurance was significantly linked to higher PCS scores (β: 2.4, 95% CI: 0.1 to 4.6), whereas current tobacco use was linked to lower MCS scores (β: −3.7, 95% CI: −7.4 to −0.02). A duration of dialysis ≥5 years was significantly associated with lower EQ-5D-5 L index scores (β: −0.17, 95% CI: −0.31 to −0.04). Comorbidities, age, and sex were not significantly associated with any of the HRQoL measures.

HRQoL among HD patients in southern Iran was markedly reduced and influenced by socioeconomic, lifestyle, and treatment-related factors. Enhancing patient education, expanding insurance coverage, addressing gaps in social support, and incorporating lifestyle interventions—such as smoking cessation—may be associated with modest improvements in HRQoL outcomes in this population.