A cross-sectional study in southern Iran links health-related quality of life to socioeconomic and lifestyle factors more than age or sex.

People on maintenance hemodialysis reported markedly reduced health-related quality of life across multiple measures. Better education and supplemental insurance were linked to higher scores, while smoking, being divorced or widowed, being retired or disabled, and longer time on dialysis were linked to lower scores. Age, sex, and comorbidities were not significantly associated with these quality-of-life measures in this study.

Quick summary

• What the study found: Health-related quality of life was low; higher education and supplemental insurance were associated with better scores, while smoking, certain social and work statuses, and at least five years on dialysis were associated with worse scores.
• Why it matters: It points to practical, modifiable targets around support, coverage, education, and smoking cessation, alongside medical care.
• What to be careful about: Because the design was cross-sectional, these links cannot prove cause and effect.

What was found

The journal article Health-related quality of life in patients on maintenance hemodialysis: Evidence from southern Iran using EQ-5D-5L and KDQOL-SF assessed adults receiving hemodialysis in Bandar Abbas, Iran. Health-related quality of life was measured using the EQ-5D-5L index, the EQ visual analog scale, and the 12-Item Short Form Survey physical and mental component scores.

Average scores were low: EQ-5D-5L index 0.50, EQ visual analog scale 64.9, physical component 42.3, and mental component 42.3. In multivariable models, higher education levels were associated with better EQ-5D-5L index scores.

Being divorced or widowed and being retired or disabled were associated with lower EQ visual analog scale scores. Having supplemental insurance was linked to higher physical component scores, while current tobacco use was linked to lower mental component scores.

Dialysis duration of at least five years was associated with a lower EQ-5D-5L index score. Age, sex, and comorbidities were not significantly associated with any of the health-related quality-of-life measures.

What it means

Health-related quality of life is a person’s self-reported functioning and well-being, not just lab values or survival. The pattern here suggests that daily resources and strain may shape life on dialysis as much as clinical complexity.

Education can reflect health literacy, problem-solving skills, and comfort navigating systems. Insurance coverage can reduce financial stress and improve access to supportive services that protect physical functioning.

The links with divorce or widowhood and with retirement or disability fit a basic social support model: fewer practical helpers and more isolation can worsen symptoms, motivation, and coping. Smoking’s association with poorer mental scores is consistent with nicotine’s tight relationship with stress, withdrawal cycles, and depression risk.

Where it fits

Dialysis is time-intensive and physically taxing, so quality of life often becomes the central outcome patients feel. This study reinforces a biopsychosocial view: biology matters, but social position, habits, and treatment burden also show up in patient-reported outcomes.

It also challenges a common assumption that worse quality of life is automatically explained by age, sex, or number of diagnoses. In this sample, those factors did not show significant associations with the quality-of-life measures used.

How to use it

Clinics can treat quality of life like a vital sign by routinely tracking patient-reported scores and flagging abrupt declines. When risk markers are present, add targeted support rather than generic advice.

Practical moves include plain-language education, help completing insurance steps, and proactive referral to social work for people who are divorced or widowed. For tobacco use, integrate smoking cessation into dialysis care, with brief counseling and follow-up that fits dialysis schedules.

Limits & what we still don’t know

This was a cross-sectional study, so it cannot show that education, insurance, or smoking causes changes in quality of life. Reverse causality is plausible, and unmeasured factors could explain part of the associations.

We also do not learn from the excerpt which specific services were covered by supplemental insurance or what cessation supports were available. Future work needs longitudinal tracking and tests of targeted interventions.

Closing takeaway

For people on hemodialysis, low quality of life is not just a medical issue; it tracks with education, coverage, smoking, social status, and time on treatment. The highest-yield next steps are to strengthen education and support, broaden access, and address tobacco use alongside routine dialysis care.

Data in this article is provided by PLOS.

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