Dialysis Adequacy and Quality of Life Among Haemodialysis Patients: Does Facility Type Matter? A Comparison Between Government and Private Centres in Klang Valley, Malaysia.

INTRODUCTION: Patients with end-stage kidney disease (ESKD) receiving haemodialysis (HD) face a substantial burden of physical and psychological challenges, with dialysis adequacy recognised as a key determinant of quality of life (QoL). The number of HD patients in Malaysia continues to grow, with more than half receiving treatment at private dialysis centres. This study compares dialysis adequacy and QoL between patients attending government and private HD centres in Klang Valley, Malaysia. MATERIALS AND METHODS: An observational cross-sectional study was conducted in three private and two government dialysis centres in Selangor, Malaysia, between August and December 2024. Data were collected from 294 HD patients using a structured questionnaire on sociodemographic and clinical information, alongside the KDQOL-36. Good dialysis adequacy was defined a priori as single-pool Kt/V > 1.2, with a stricter threshold of Kt/V > 1.5 examined as a sensitivity analysis. RESULTS AND DISCUSSION: Private HD centre patients were significantly older (p < 0.001) but had lower dialysis vintage (p < 0.001), lower Kt/V (p < 0.001) and higher iPTH levels (p = 0.033). Government HD centre patients had significantly better physical functioning (p < 0.001) and SF-12 physical scores (p = 0.019). At the primary threshold (Kt/V > 1.2), the independent predictors of good dialysis adequacy after multivariable adjustment were female gender (OR = 2.37, 95% CI 1.10-5.09, p = 0.027), treatment at a government centre (OR = 3.60, 95% CI 1.32-9.86, p = 0.013) and lower dry weight (OR = 0.96 per kg, 95% CI 0.93-0.98, p < 0.001). These predictors were unchanged in the sensitivity analysis at Kt/V > 1.5, in which higher educational attainment additionally predicted poorer adequacy. Dialysis adequacy was not independently associated with QoL; physical QoL was predicted by younger age and shorter dialysis vintage and mental QoL by female gender and Malay ethnicity. CONCLUSIONS: Government HD centre patients in Malaysia had significantly better dialysis adequacy than those in private centres. Female gender and government centre affiliation were independent predictors of good Kt/V, whereas higher dry weight was associated with poorer adequacy. Most KDQOL domains were comparable between facility types, though government centre patients reported better physical functioning and physical component scores. These findings highlight the need for regulatory oversight of dialysis practice standards across facility types and suggest that individualised prescription optimisation, particularly to patient body size, is an important target for improving dialysis adequacy in Malaysia.