Health-related quality of life and its domains as independent predictors of all-cause mortality in maintenance hemodialysis: a prospective multicenter cohort study

Introduction Despite advances in dialysis care, mortality remains high among maintenance hemodialysis patients. Health-related quality of life (HRQoL) may provide prognostic information beyond conventional risk factors. This study examined the association of overall HRQoL and its domains with all-cause mortality.Materials and methods In this prospective multicenter cohort study, 307 maintenance hemodialysis patients from five dialysis centers in Isfahan, Iran, were followed for three years. Baseline HRQoL was assessed using the Kidney Disease Quality of Life Short Form (KDQOL-SF 1.3). Cox proportional hazards and Kaplan–Meier analyses were performed.Results Higher overall HRQoL was independently associated with lower mortality (HR: 0.984; 95% CI: 0.971–0.997; p = 0.019). Better physical functioning (HR: 0.985; 95% CI: 0.977–0.992; p < 0.001), fewer kidney disease–related symptoms (HR: 0.984; 95% CI: 0.971–0.998; p = 0.022), better role-emotional functioning (HR: 0.994; 95% CI: 0.990–0.999; p = 0.012), and higher physical (HR: 0.973; 95% CI: 0.953–0.993; p = 0.010) and mental (HR: 0.983; 95% CI: 0.966–1.000; p = 0.047) composite scores predicted better survival. HRQoL significantly improved risk prediction beyond established clinical factors. Physical functioning showed the greatest incremental prognostic value (LR χ2 = 15.43, p < 0.001) and best model fit (AIC = 1037.97; BIC = 1082.69). Above-median HRQoL was also associated with higher survival (log-rank p < 0.001).Conclusion Higher HRQoL independently predicted better survival in maintenance hemodialysis patients, with physical functioning providing the greatest incremental prognostic value.