Association of Dialysis Adequacy with Health-Related Quality of Life Among Maintenance Hemodialysis Patients: A Cross-Sectional Study

Background: Hemodialysis is used as renal replacement treatment to extend patients' lives. Adequate and effective dialysis can improve patients’ quality of life; however, there is a lack of data regarding dialysis adequacy and its impact on quality of life (QOL) among hemodialysis patients in the Yemeni context. Objective: To assess the association between dialysis adequacy and health‑related quality of life (HRQOL) among hemodialysis patients. Methods: A descriptive cross-sectional study was conducted among 77 patients selected from the hemodialysis center of the 22 May Hospital Authority in Amran City, Yemen, from December 2024 to April 2025, using a convenience sampling method. Data were collected through face-to-face interviews using a validated Arabic version of the Kidney Disease Quality of Life (KDQOL™-36) questionnaire and by measuring dialysis adequacy (Kt/V) according to standardized procedures. Results: This study showed 58.4% of patients received inadequate dialysis, and 41.6% achieved adequate dialysis based on KT/V values. The mean KDQOL score was 40.66, highest for symptoms/problems (49.11) and lowest for burden of kidney disease (25.65). Patients with adequate dialysis had significantly better scores for symptom/problem, effect, and burden subscales. Dialysis adequacy correlated positively with overall HRQOL (r=0.54, p<0.001). Hemoglobin >10 g/dL was also linked to higher HRQOL (p=0.006). Conclusions: Most HD patients experienced inadequate dialysis and impaired HRQOL. Dialysis adequacy and anemia control emerged as key determinants of better HRQO.