The study, led by researchers at Qassim University in collaboration with the hospital’s hemodialysis and peritoneal dialysis center, set out to answer a deceptively simple question. Physical function is widely recognized as a key indicator of health status and quality of life among dialysis patients, yet evidence on its prevalence and determinants in Saudi Arabia, particularly in the Qassim region, has remained scarce. Without locally generated data, clinicians have had limited ability to identify which patients are at greatest risk of functional decline or to design culturally appropriate rehabilitation programs.

To fill that gap, the team conducted a hospital-based analytical cross-sectional study over a 16-month period, with participant recruitment and data collection spanning four consecutive months from October 2025 to January 2026. Eligible participants were adults aged 18 or older who had been on maintenance hemodialysis for at least three months, were clinically stable, and could provide written informed consent. The researchers excluded patients with acute dialysis-related complications requiring emergency management, severe cognitive impairment, diagnosed psychiatric disorders, or unrelated medical conditions that could substantially impair physical function, such as recent stroke, major trauma, or limb amputation.

The sampling process was meticulous. Using G*Power statistical software, the team calculated a minimum required sample of 118 participants for multiple regression analysis, assuming a medium effect size, a significance level of 0.05, and 80 percent statistical power. In practice, 130 eligible patients were approached, five declined, 12 participated in a pilot study and were excluded from the final analysis, and three withdrew, leaving a final analytical sample of 110. Data were collected through a structured electronic questionnaire distributed via QR code during scheduled dialysis sessions, with trained research assistants providing standardized assistance to participants who had difficulty completing the survey because of advanced age, limited literacy, or visual impairment.

The questionnaire comprised three validated sections. The first captured sociodemographic and clinical characteristics, including age, gender, education, marital status, dialysis duration, and comorbidities. The second was a 40-item Physical Function Questionnaire assessing mobility, self-care, household activities, and physical exercise, scored on a four-point independence scale and classified using a 50-point threshold referenced from prior literature. The third section evaluated anthropometric measurements, laboratory parameters such as serum calcium, iron, ferritin, and albumin, and common dialysis-related symptoms. Both the physical function instrument and the clinical health status section demonstrated good internal consistency, with Cronbach’s alpha coefficients of 0.85 and 0.81 respectively.

The results were striking. The mean age of participants was 56.8 years, with more than a third aged over 60. Most were married, unemployed, and had one or more comorbid conditions. The mean duration of hemodialysis was 4.8 years, and nearly 95 percent underwent three sessions per week. When physical function scores were converted to percentages of the maximum possible score, the mean was just 37.7 percent, well below the 50 percent cutoff. Eighty-one of the 110 participants, or 73.6 percent, were classified as having impaired physical function, while only 29, or 26.4 percent, preserved adequate function.

The pattern of functional limitation was revealing. Most participants remained independent in basic self-care activities: 76.4 percent could use the toilet independently, 75.5 percent could dress themselves, 65.5 percent could walk, and 57.3 percent could bathe without assistance. But independence collapsed when it came to instrumental activities of daily living. Only 9.1 percent could clean floors independently, 5.5 percent could wash clothes manually, 17.3 percent could cook, 22.7 percent could carry objects, and just 7.3 percent could participate in sports or exercise. Conversely, 78.2 percent reported being unable to wash clothes manually, 70.9 percent could not engage in exercise, and 63.6 percent could not cook. This gradient, preserved basic self-care alongside profound limitations in more physically demanding tasks, suggests that functional decline in dialysis patients follows a predictable trajectory, eroding higher-capacity activities first.

Participants also reported substantial symptom burdens that likely compound their functional challenges. Fatigue was nearly universal, reported by 93.6 percent of participants after dialysis sessions. Sleep disturbances were widespread: 60.9 percent rarely slept well, 60.9 percent always woke at night feeling anxious or stressed, and 56.4 percent always experienced insomnia. Headache affected 37.3 percent, and more than half rated their current health as good while nearly a third perceived their health as worse than the previous year. These symptoms, alongside pain during physical activity reported always by 31.8 percent of participants, paint a picture of a population caught in a cycle where exhaustion, poor sleep, and discomfort reinforce physical inactivity and further functional decline.

When the researchers examined which characteristics were associated with physical function, age emerged as the dominant factor. A statistically significant association was observed between age group and physical function, with the proportion of impaired participants rising from just 17.2 percent among those aged over 60 who preserved function to 50.6 percent of those over 60 with impairment. No significant associations were found with gender, marital status, educational level, employment status, dialysis duration, dialysis frequency, family history of kidney disease, or comorbidities. Multivariable binary logistic regression confirmed that increasing age remained independently associated with impaired physical function after adjustment for sex, body mass index, dialysis duration, hemoglobin, serum albumin, and comorbidity status, with each additional year of age associated with approximately a 7.7 percent increase in the odds of impairment.

The laboratory findings added a nutritional dimension. Participants with impaired physical function had significantly lower mean serum albumin levels than those with preserved function, 39.2 versus 41.5 grams per liter, a difference that reached statistical significance. Lower albumin may indicate less favorable nutritional or clinical status and greater functional vulnerability, though the cross-sectional design precludes establishing causation. Hemoglobin, serum creatinine, calcium, iron, and ferritin did not differ significantly between the two groups, and elevated ferritin concentrations should be interpreted cautiously as they may reflect both iron stores and the inflammatory milieu common in dialysis patients.

The researchers framed their findings through Lazarus and Folkman’s Stress and Coping Theory, which views chronic illness as a dynamic process in which individuals continuously appraise disease-related demands and mobilize coping resources to adapt. Within this framework, maintenance hemodialysis represents a persistent physiological and psychosocial stressor requiring sustained behavioral, emotional, and physical adaptation. Functional status, in this view, reflects not only the severity of clinical condition but also the balance between treatment-related demands, personal coping resources, social support, and healthcare interventions. The theory provides a nursing perspective for understanding functional decline and supports interventions aimed at strengthening adaptive capacity and preserving independence.

The implications for clinical practice are substantial. The authors argue that routine assessment of physical function should be incorporated into standard dialysis care to facilitate early identification of at-risk patients. Regular evaluation of activities of daily living, mobility, fatigue, and sleep quality may enable healthcare professionals to implement timely, individualized interventions. From a nursing perspective, multidisciplinary strategies incorporating exercise training, nutritional counseling, fatigue management, sleep hygiene education, and psychosocial support should be integrated into routine hemodialysis care. Structured rehabilitation programs and patient education initiatives may enhance self-management, promote physical activity, and reduce functional deterioration, particularly among older patients who face the greatest risk.

The study does carry limitations that temper its conclusions. The cross-sectional design precludes establishing causal relationships, and the single-center setting, convenience sampling, and self-reported assessment of physical function may limit generalizability and introduce recall or reporting bias. Comorbidities were assessed as an overall presence or absence without detailed information on individual conditions, precluding analysis of specific comorbidities such as diabetes. Several potentially relevant determinants, including frailty, sarcopenia, muscle wasting, physical activity levels, depression, and inflammatory biomarkers, were not directly assessed. The high prevalence of post-dialysis fatigue also limited its reliable evaluation as an independent factor. Future multicenter prospective studies with larger and more diverse samples and comprehensive clinical, nutritional, psychosocial, and objective functional assessments are warranted.

Nevertheless, the central message resonates beyond Buraydah. As the global burden of chronic kidney disease continues to rise, resulting in increasing numbers of individuals requiring long-term dialysis, maintaining physical function has become a key therapeutic objective that directly influences patients’ ability to remain independent and achieve better clinical outcomes. Declining physical function has been consistently associated with frailty, reduced quality of life, increased hospitalization, greater dependence on caregivers, and higher mortality among patients with end-stage renal disease. The Buraydah findings, showing that nearly three-quarters of dialysis patients carry substantial functional limitations with age as the only independent marker, underscore the urgency of embedding functional assessment and age-sensitive rehabilitation into comprehensive renal care. For a population whose survival now depends on machines, the study reminds clinicians that preserving the ability to cook a meal, wash clothes, or take a walk may be as vital to quality of life as any laboratory value.

Subject of Research: Prevalence and factors associated with physical function among patients undergoing maintenance hemodialysis in Buraydah, Saudi Arabia: a cross-sectional study

Article Title: Prevalence and factors associated with physical function among patients undergoing maintenance hemodialysis in Buraydah, Saudi Arabia: a cross-sectional study

Article References: Qalawa, S. A. A., AlQassem, W. A., Alomeri, K. M., Alharbi, K. S. A., ALsallom, A. I., Elmansy, F. M., & Elbqry, M. G. (2026). Prevalence and factors associated with physical function among patients undergoing maintenance hemodialysis in Buraydah, Saudi Arabia: a cross-sectional study. Frontiers in Nephrology, 6, Article 1935072. https://doi.org/10.3389/fneph.2026.1935072

Image Credits: AI Generated

DOI: 10.3389/fneph.2026.1935072

Keywords: Prevalence, factors, associated, physical, function, patients, undergoing, maintenance, hemodialysis, Buraydah, Saudi, Arabia