Beyond Clinical Parameters: Travel Burden, Caregiver Support, and Digital Access as Determinants of Quality of Life in Hemodialysis
SN Comprehensive Clinical Medicine, cilt.8, sa.1, 2026 (Scopus)
- Yayın Türü: Makale / Tam Makale
- Cilt numarası: 8 Sayı: 1
- Basım Tarihi: 2026
- Doi Numarası: 10.1007/s42399-026-02463-z
- Dergi Adı: SN Comprehensive Clinical Medicine
- Derginin Tarandığı İndeksler: Scopus, EMBASE, Health Research Premium Collection (ProQuest)
- Anahtar Kelimeler: Chronic kidney disease, Health care accessibility, Hemodialysis, Quality of life, Social determinants of health
- Hacettepe Üniversitesi Adresli: Evet
Özet
Purpose: Quality of life (QoL) in hemodialysis patients is influenced by clinical factors, but social-contextual determinants, including healthcare accessibility, caregiver support, and digital access, remain understudied. This study examined whether these modifiable social-contextual factors are independently associated with QoL beyond traditional clinical parameters. Methods: A cross-sectional study of 309 patients receiving maintenance hemodialysis across three centers assessed QoL using the Kidney Disease Quality of Life Short Form-36 (KDQOL-36). Univariable analysis and multivariable linear regression were applied to identify factors independently associated with QoL. Results: Travel time ≥ 45 min was independently associated with worse disease burden (β = −9.37, p < 0.001), symptoms (β = −8.93, p = 0.001), and physical health (β = −4.06, p < 0.001); effect sizes numerically comparable to or exceeding those of diabetes within the same adjusted model. Patients managing self-care without family support showed significantly worse physical health versus those with spousal caregivers (β = −6.30, p < 0.001). Lack of smartphone ownership predicted lower physical health scores (β = −2.96, p = 0.002). Hemoglobin remained the strongest clinical predictor across all domains; lower educational attainment and female sex were associated with higher disease burden. Conclusions: Quality of life in hemodialysis patients is associated with modifiable social-contextual factors, including travel burden, caregiver support structures, and digital access, alongside anemia and educational attainment. Findings support the need for healthcare accessibility improvements, caregiver-inclusive care models, and attention to digital health equity in nephrology care.