Adult patients (aged ≥18 years) with ESKD who underwent hemodialysis at King Salman Center for Kidney Disease (KSCKD) and King Fahad Medical City (KFMC), Riyadh, Saudi Arabia, between June and July 2021, and had been on dialysis for ≥1 year were included in this cross-sectional study if they consented to participate. Patients who had cognitive impairment and/or debilitating diseases (except hypertension, diabetes, and cardiovascular diseases) were excluded from the study to avoid confounding effects. This study used convenience sampling.
KSCKD is the main outpatient dialysis unit in Riyadh Second Health Cluster, and the largest dialysis center in Riyadh with a total capacity of 600 patients, and with >52,000 hemodialysis sessions per year.[12 ] The dialysis unit at KFMC, a tertiary hospital at Riyadh Second Health Cluster, has a total capacity of up to 100 patients. KSCKD and KFMC are two of the largest centers for both hemodialysis and peritoneal dialysis not only in Saudi Arabia but also in the Middle East. Therefore, the patient population undergoing in these centers is diverse and representative of the population.
Ethical approval for this study was obtained from the Institutional Review Board of KFMC. Written informed consents were obtained from the patients before participation.