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Journal of Medicine and Palliative Care

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Original Article
The relationship between anemia and health-related QoL in patients with chronic kidney disease receiving hemodialysis treatment
Abstract
Aims: Anemia is a frequent complication in hemodialysis patients and associated with a poor quality of life (QoL). Our goal was to examine the connection between anemia and health-related QoL (HR-QoL) in those with renal failure receiving hemodialysis treatment.
Methods: In this cross-sectional study, 128 subjects that underwent hemodialysis volunteered. Demographic, clinical, and laboratory parameters and QoL using SF-12 were assessed. Socio-demographic characteristics in patients with and without anemia according to hemoglobin value were compared. The scores obtained from the physical (PCS12) and mental subscales (MCS12) of the SF-health survey were compared with other variables (age, gender, education, smoking, marital status, comorbidity, BMI, duration of hemodialysis, hemoglobin values). Regression analyses were conducted using PCS12 and MCS12 as the independent variables.
Results: There were 27 (21.1%) patients with Hb values between 10-11 and 38 (29.7%) patients with Hb values below 10. The findings of this study indicated that an early age (p=0.001) and higher education (p=0.009) were linked to improved QoL, while no association was found with anemia (p=0.228). Smoking was also found to be significant (p=0.01) for better scores. Univariate linear regression analysis was performed to evaluate the interaction or relationship between age and smoking. Smoking was found to be an effective risk factor in patients younger than 65 years, but not in patients older than 65 years. The comparison of socio-demographic characteristics between patients with and without anemia revealed that married patients exhibited statistically significant higher hemoglobin levels (p=0.001).
Conclusion: A notable association was identified between the physical aspect of the SF-12 survey and both younger age and higher educational level, whereas no such relationship was observed for the mental aspect. The findings indicated that younger individuals with higher education levels experienced an improved physical QoL. However, no link has been found between anemia and QoL.

Keywords : Chronic kidney disease, chronic renal failure, hemodialysis, anemia, health-related quality of life

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1. Evans M, Lewis RD, Morgan AR, et al. A narrative review of chronic kidney disease in clinical practice: current challenges and future perspectives. Adv Ther. 2022;39(1):33-43. doi:10.1007/s12325-021-01927-z
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3. Hanna RM, Streja E, Kalantar-Zadeh K. Burden of anemia in chronic kidney disease: beyond erythropoietin. Adv Ther. 2021;38(1):52-75. doi: 10.1007/s12325-020-01524-6
4. Pramod S, Goldfarb DS. Challenging patient phenotypes in the management of anaemia of chronic kidney disease. Int J Clin Pract. 2021;75(11):e14681. doi:10.1111/ijcp.14681
5. Van Haalen H, Jackson J, Spinowitz B, Milligan G, Moon R. Impact of chronic kidney disease and anemia on health-related quality of life and work productivity: analysis of multinational real-world data. BMC Nephrol. 2020;21(1):88. doi:10.1186/s12882-020-01746-4
6. Gafter-Gvili A, Schechter A, Rozen-Zvi B. Iron deficiency anemia in chronic kidney disease. Acta Haematol. 2019;142(1):44-50. doi:10.1159/ 000496492
7. Al-Jabi SW, Rajabi NS, Koni AA, Zyoud SH. A multicenter descriptive analysis of anemia management in hemodialysis patients and its association with quality of life. BMC Nephrol. 2023;24(1):197. doi:10. 1186/s12882-023-03254-7
8. Arnett DK, Blumenthal RS, Albert MA, et al. 2019 ACC/AHA Guideline on the primary prevention of cardiovascular disease: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2019;140(11):e596-e646. doi:10.1161/CIR.0000000000000678
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12. Ware JE, Kosinski M, Keller SD. SF-12: how to score the SF-12 physical and mental health summary scales. 1995; Boston: The Health Institute, New England Medical Center.
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15. Mahato SKS, Apidechkul T, Sriwongpan P, et al. Factors associated with quality of life among chronic kidney disease patients in Nepal: a cross-sectional study. Health Qual Life Outcomes. 2020;18(1):207. doi:10.1186/s12955-020-01458-1
16. Chen JY, Wan EYF, Choi EPH, et al. The health-related quality of life of Chinese Patients on hemodialysis and peritoneal dialysis. Patient. 2017; 10(6):799-808. doi:10.1007/s40271-017-0256-6
17. Molsted S, Wendelboe S, Flege MM, Eidemak I. The impact of marital and socioeconomic status on quality of life and physical activity in patients with chronic kidney disease. Int Urol Nephrol. 2021;53(12):2577-2582. doi:10.1007/s11255-021-02826-6
18. Floria I, Kontele I, Grammatikopoulou MG, Sergentanis TN, Vassilakou T. Quality of life of hemodialysis patients in Greece: associations with socio-economic, anthropometric and nutritional factors. Int J Environ Res Public Health. 2022;19(22):15389. doi:10.3390/ijerph192215389
19. Ku E, Del Vecchio L, Eckardt KU, et al. Novel anemia therapies in chronic kidney disease: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference. Kidney Int. 2023;104(4):655-680. doi:10.1016/j.kint.2023.05.009
20. Collister D, Komenda P, Hiebert B, et al. The effect of erythropoieitin- stimulating agents on health-related quality of life in anemia of chronic kidney disease: a systematic review and meta-analysis. Ann Intern Med. 2016;164(7):472-478. doi:10.7326/M15-1839
21. Staibano P, Perelman I, Lombardi J, et al. Patient-centred outcomes in anaemia and renal disease: a systematic review. Kidney Dis (Basel). 2020;6(2):74-84. doi:10.1159/000502208
22. Pretto CR, Winkelmann ER, Hildebrandt LM, Barbosa DA, Colet CF, Stumm EMF. Quality of life of chronic kidney patients on hemodialysis and related factors. Rev Lat Am Enfermagem. 2020;28:e3327. doi:10.1590/ 1518-8345.3641.3327
23. Jalal SM, Beth MRM, Bo Khamseen ZM. Impact of hospitalzation on the quality of life of patients with chronic kidney disease in Saudi Arabia. Int J Environ Res Public Health. 2022;19(15):971. doi:10.3390/ijerph1915918
24. Jesus NM, Souza GF, Mendes-Rodrigues C, Almeida Neto OP, Rodrigues DDM, Cunha CM. Quality of life of individuals with chronic kidney disease on dialysis. J Bras Nefrol. 2019;41(3):364-374. doi:10.1590/2175-8239-JBN-2018-0152
25. Busa I, Ordóñez-Mena JM, Yang Y, et al. Quality of life in older adults with chronic kidney disease and transient changes in renal function: findings from the Oxford Renal cohort. PLoS One. 2022;17(10):e0275572. doi:10.1371/journal.pone.0275572
1. Evans M, Lewis RD, Morgan AR, et al. A narrative review of chronic kidney disease in clinical practice: current challenges and future perspectives. Adv Ther. 2022;39(1):33-43. doi:10.1007/s12325-021-01927-z
2. https://www.aa.com.tr/tr/saglik/turk-nefroloji-dernegi-bobrek-hastaliklarina-ve-yayginligina-dikkati-cekti/3163411. (Accessed on 24. 09.2024).
3. Hanna RM, Streja E, Kalantar-Zadeh K. Burden of anemia in chronic kidney disease: beyond erythropoietin. Adv Ther. 2021;38(1):52-75. doi: 10.1007/s12325-020-01524-6
4. Pramod S, Goldfarb DS. Challenging patient phenotypes in the management of anaemia of chronic kidney disease. Int J Clin Pract. 2021;75(11):e14681. doi:10.1111/ijcp.14681
5. Van Haalen H, Jackson J, Spinowitz B, Milligan G, Moon R. Impact of chronic kidney disease and anemia on health-related quality of life and work productivity: analysis of multinational real-world data. BMC Nephrol. 2020;21(1):88. doi:10.1186/s12882-020-01746-4
6. Gafter-Gvili A, Schechter A, Rozen-Zvi B. Iron deficiency anemia in chronic kidney disease. Acta Haematol. 2019;142(1):44-50. doi:10.1159/ 000496492
7. Al-Jabi SW, Rajabi NS, Koni AA, Zyoud SH. A multicenter descriptive analysis of anemia management in hemodialysis patients and its association with quality of life. BMC Nephrol. 2023;24(1):197. doi:10. 1186/s12882-023-03254-7
8. Arnett DK, Blumenthal RS, Albert MA, et al. 2019 ACC/AHA Guideline on the primary prevention of cardiovascular disease: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2019;140(11):e596-e646. doi:10.1161/CIR.0000000000000678
9. KDIGO clinical practice guideline for anemia in chronic kidney disease. https://kdigo.org/2023/ on 21.03.2025).
10. Turgeon ML. Cinical Hematology Theory&Procedures. Fifth edition. 2012. Wolters Kluwer, Lippincott Williams&Wilkins. Chapter 10. Iron deficiency Anemia and Anemia of Chronic Inflammation. pp.173-176.
11. Weiss G, Goodnough LT. Anemia of chronic disease. N Engl J Med. 2005;352(10):1011-1023. doi:10.1056/NEJMra041809
12. Ware JE, Kosinski M, Keller SD. SF-12: how to score the SF-12 physical and mental health summary scales. 1995; Boston: The Health Institute, New England Medical Center.
13. Soylu C, Bahtım K. Reliability and Validity of the Turkish Version of SF-12 Health Survey. SF-12 Yaşam Kalitesi Ölçeği’nin türkçe formunun güvenirlik ve geçerlilik çalışması. Turk Psikiyatri Derg. 2022;33(2):108-117. doi:10.5080/u25700
14. Doan KVD, Nguyen HTM, Nguyen NTH, Dang KC, Yang SH, Duong TV. Associations of socio-demographic, clinical and biochemical parameters with healthcare cost, health- and renal-related quality of life in hemodialysis patients: a clinical observational study. Int J Environ Res Public Health. 2020;17(18):6552. doi:10.3390/ijerph17186552
15. Mahato SKS, Apidechkul T, Sriwongpan P, et al. Factors associated with quality of life among chronic kidney disease patients in Nepal: a cross-sectional study. Health Qual Life Outcomes. 2020;18(1):207. doi:10.1186/s12955-020-01458-1
16. Chen JY, Wan EYF, Choi EPH, et al. The health-related quality of life of Chinese Patients on hemodialysis and peritoneal dialysis. Patient. 2017; 10(6):799-808. doi:10.1007/s40271-017-0256-6
17. Molsted S, Wendelboe S, Flege MM, Eidemak I. The impact of marital and socioeconomic status on quality of life and physical activity in patients with chronic kidney disease. Int Urol Nephrol. 2021;53(12):2577-2582. doi:10.1007/s11255-021-02826-6
18. Floria I, Kontele I, Grammatikopoulou MG, Sergentanis TN, Vassilakou T. Quality of life of hemodialysis patients in Greece: associations with socio-economic, anthropometric and nutritional factors. Int J Environ Res Public Health. 2022;19(22):15389. doi:10.3390/ijerph192215389
19. Ku E, Del Vecchio L, Eckardt KU, et al. Novel anemia therapies in chronic kidney disease: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference. Kidney Int. 2023;104(4):655-680. doi:10.1016/j.kint.2023.05.009
20. Collister D, Komenda P, Hiebert B, et al. The effect of erythropoieitin- stimulating agents on health-related quality of life in anemia of chronic kidney disease: a systematic review and meta-analysis. Ann Intern Med. 2016;164(7):472-478. doi:10.7326/M15-1839
21. Staibano P, Perelman I, Lombardi J, et al. Patient-centred outcomes in anaemia and renal disease: a systematic review. Kidney Dis (Basel). 2020;6(2):74-84. doi:10.1159/000502208
22. Pretto CR, Winkelmann ER, Hildebrandt LM, Barbosa DA, Colet CF, Stumm EMF. Quality of life of chronic kidney patients on hemodialysis and related factors. Rev Lat Am Enfermagem. 2020;28:e3327. doi:10.1590/ 1518-8345.3641.3327
23. Jalal SM, Beth MRM, Bo Khamseen ZM. Impact of hospitalzation on the quality of life of patients with chronic kidney disease in Saudi Arabia. Int J Environ Res Public Health. 2022;19(15):971. doi:10.3390/ijerph1915918
24. Jesus NM, Souza GF, Mendes-Rodrigues C, Almeida Neto OP, Rodrigues DDM, Cunha CM. Quality of life of individuals with chronic kidney disease on dialysis. J Bras Nefrol. 2019;41(3):364-374. doi:10.1590/2175-8239-JBN-2018-0152
25. Busa I, Ordóñez-Mena JM, Yang Y, et al. Quality of life in older adults with chronic kidney disease and transient changes in renal function: findings from the Oxford Renal cohort. PLoS One. 2022;17(10):e0275572. doi:10.1371/journal.pone.0275572
1. Evans M, Lewis RD, Morgan AR, et al. A narrative review of chronic kidney disease in clinical practice: current challenges and future perspectives. Adv Ther. 2022;39(1):33-43. doi:10.1007/s12325-021-01927-z
2. https://www.aa.com.tr/tr/saglik/turk-nefroloji-dernegi-bobrek-hastaliklarina-ve-yayginligina-dikkati-cekti/3163411. (Accessed on 24. 09.2024).
3. Hanna RM, Streja E, Kalantar-Zadeh K. Burden of anemia in chronic kidney disease: beyond erythropoietin. Adv Ther. 2021;38(1):52-75. doi: 10.1007/s12325-020-01524-6
4. Pramod S, Goldfarb DS. Challenging patient phenotypes in the management of anaemia of chronic kidney disease. Int J Clin Pract. 2021;75(11):e14681. doi:10.1111/ijcp.14681
5. Van Haalen H, Jackson J, Spinowitz B, Milligan G, Moon R. Impact of chronic kidney disease and anemia on health-related quality of life and work productivity: analysis of multinational real-world data. BMC Nephrol. 2020;21(1):88. doi:10.1186/s12882-020-01746-4
6. Gafter-Gvili A, Schechter A, Rozen-Zvi B. Iron deficiency anemia in chronic kidney disease. Acta Haematol. 2019;142(1):44-50. doi:10.1159/ 000496492
7. Al-Jabi SW, Rajabi NS, Koni AA, Zyoud SH. A multicenter descriptive analysis of anemia management in hemodialysis patients and its association with quality of life. BMC Nephrol. 2023;24(1):197. doi:10. 1186/s12882-023-03254-7
8. Arnett DK, Blumenthal RS, Albert MA, et al. 2019 ACC/AHA Guideline on the primary prevention of cardiovascular disease: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2019;140(11):e596-e646. doi:10.1161/CIR.0000000000000678
9. KDIGO clinical practice guideline for anemia in chronic kidney disease. https://kdigo.org/2023/ on 21.03.2025).
10. Turgeon ML. Cinical Hematology Theory&Procedures. Fifth edition. 2012. Wolters Kluwer, Lippincott Williams&Wilkins. Chapter 10. Iron deficiency Anemia and Anemia of Chronic Inflammation. pp.173-176.
11. Weiss G, Goodnough LT. Anemia of chronic disease. N Engl J Med. 2005;352(10):1011-1023. doi:10.1056/NEJMra041809
12. Ware JE, Kosinski M, Keller SD. SF-12: how to score the SF-12 physical and mental health summary scales. 1995; Boston: The Health Institute, New England Medical Center.
13. Soylu C, Bahtım K. Reliability and Validity of the Turkish Version of SF-12 Health Survey. SF-12 Yaşam Kalitesi Ölçeği’nin türkçe formunun güvenirlik ve geçerlilik çalışması. Turk Psikiyatri Derg. 2022;33(2):108-117. doi:10.5080/u25700
14. Doan KVD, Nguyen HTM, Nguyen NTH, Dang KC, Yang SH, Duong TV. Associations of socio-demographic, clinical and biochemical parameters with healthcare cost, health- and renal-related quality of life in hemodialysis patients: a clinical observational study. Int J Environ Res Public Health. 2020;17(18):6552. doi:10.3390/ijerph17186552
15. Mahato SKS, Apidechkul T, Sriwongpan P, et al. Factors associated with quality of life among chronic kidney disease patients in Nepal: a cross-sectional study. Health Qual Life Outcomes. 2020;18(1):207. doi:10.1186/s12955-020-01458-1
16. Chen JY, Wan EYF, Choi EPH, et al. The health-related quality of life of Chinese Patients on hemodialysis and peritoneal dialysis. Patient. 2017; 10(6):799-808. doi:10.1007/s40271-017-0256-6
17. Molsted S, Wendelboe S, Flege MM, Eidemak I. The impact of marital and socioeconomic status on quality of life and physical activity in patients with chronic kidney disease. Int Urol Nephrol. 2021;53(12):2577-2582. doi:10.1007/s11255-021-02826-6
18. Floria I, Kontele I, Grammatikopoulou MG, Sergentanis TN, Vassilakou T. Quality of life of hemodialysis patients in Greece: associations with socio-economic, anthropometric and nutritional factors. Int J Environ Res Public Health. 2022;19(22):15389. doi:10.3390/ijerph192215389
19. Ku E, Del Vecchio L, Eckardt KU, et al. Novel anemia therapies in chronic kidney disease: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference. Kidney Int. 2023;104(4):655-680. doi:10.1016/j.kint.2023.05.009
20. Collister D, Komenda P, Hiebert B, et al. The effect of erythropoieitin- stimulating agents on health-related quality of life in anemia of chronic kidney disease: a systematic review and meta-analysis. Ann Intern Med. 2016;164(7):472-478. doi:10.7326/M15-1839
21. Staibano P, Perelman I, Lombardi J, et al. Patient-centred outcomes in anaemia and renal disease: a systematic review. Kidney Dis (Basel). 2020;6(2):74-84. doi:10.1159/000502208
22. Pretto CR, Winkelmann ER, Hildebrandt LM, Barbosa DA, Colet CF, Stumm EMF. Quality of life of chronic kidney patients on hemodialysis and related factors. Rev Lat Am Enfermagem. 2020;28:e3327. doi:10.1590/ 1518-8345.3641.3327
23. Jalal SM, Beth MRM, Bo Khamseen ZM. Impact of hospitalzation on the quality of life of patients with chronic kidney disease in Saudi Arabia. Int J Environ Res Public Health. 2022;19(15):971. doi:10.3390/ijerph1915918
24. Jesus NM, Souza GF, Mendes-Rodrigues C, Almeida Neto OP, Rodrigues DDM, Cunha CM. Quality of life of individuals with chronic kidney disease on dialysis. J Bras Nefrol. 2019;41(3):364-374. doi:10.1590/2175-8239-JBN-2018-0152
25. Busa I, Ordóñez-Mena JM, Yang Y, et al. Quality of life in older adults with chronic kidney disease and transient changes in renal function: findings from the Oxford Renal cohort. PLoS One. 2022;17(10):e0275572. doi:10.1371/journal.pone.0275572
Article available in :
Volume 6, Issue 3, 2025
Page : 232-238
https://doi.org/10.47582/jompac.1628493
Article Information
Received : 28 Oca 2025
Accepted : 19 May 2025
Published : 18 Haz 2025
Corresponding Author :

Canan Emiroğlu: Department of Family Medicine, Ankara Etlik City Hospital, Ankara, Turkiye

[email protected]
Citation : Emiroğlu C, Gök Oğuz E, Aylı MD. The relationship between anemia and health-related QoL in patients with chronic kidney disease receiving hemodialysis treatment. J Med Palliat Care. 2025;6(3):232-238. doi:10.47582/jompac.1628493

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