Health-Related Quality of Life Among Adults Receiving Maintenance Haemodialysis in Punjab, India: A Cross-Sectional Study Using the SF-36

Background: Adults receiving maintenance haemodialysis experience substantial physical, psychological and social burdens, but domain-specific health-related quality-of-life data from northern India remain limited. Material and Methods: A hospital-based analytical cross-sectional study included 75 adults receiving maintenance haemodialysis at a tertiary-care institution in Bathinda, Punjab, between April and September 2023. Health-related quality of life was measured using the eight standard domains of the 36-Item Short Form Health Survey (SF-36), each scored from 0 to 100, with higher scores indicating better health status. Domain distributions, floor and ceiling effects, internal consistency, bivariate associations and separate multivariable linear-regression models were examined. HC3 heteroscedasticity-robust standard errors and Benjamini-Hochberg false-discovery-rate adjustment were used for sensitivity analyses. Results: The mean age was 57.04 years (SD 13.29), 56 participants (74.7%) were male, 71 (94.7%) had hypertension and 32 (42.7%) had diabetes mellitus. Mean SF-36 scores were lowest for role limitations due to physical health (40.33), role limitations due to emotional problems (40.44), physical functioning (42.20) and energy/fatigue (42.60); bodily pain had the highest mean score (58.17). Substantial floor and ceiling effects occurred in both role-limitation domains, and bodily pain showed a substantial ceiling effect. No bivariate association met the nominal two-sided threshold of p<0.05. In adjusted analysis, higher body weight was associated with lower energy/fatigue scores (B=-0.549 points per kg, 95% CI -0.958 to -0.141; p=0.009), but this association did not remain significant after false-discovery-rate adjustment (adjusted p=0.515). Conclusion: Adults receiving maintenance haemodialysis had broad impairment in health-related quality of life, particularly in physical and emotional role performance, physical functioning and vitality. The exploratory predictor analyses were inconclusive after correction for multiple testing. Larger multicentre studies incorporating biochemical, nutritional, psychological and socioeconomic factors are required.

Keywords: chronic kidney disease; haemodialysis; health-related quality of life; SF-36; patient-reported outcomes; India.