Abstract
Objective: Anemia in chronic kidney disease (CKD) contributes in decreasing quality life, but specific hemoglobin associated with quality of life is still in debate. Anemia was thought to be one of contributing factors of low physical activity in CKD, but this finding is inconsistent across studies. This research study aims to investigate the association of hemoglobin levels with quality of life and physical activity in hemodialysis patients in our settings.
 Methods: This study was conducted between March 30, 2020, and April 30, 2020, in hemodialysis unit, Wangaya Regional General Hospital, Bali. The study included 50 subjects on regular hemodialysis. Subject-reported quality of life was evaluated by interview, based on Kidney Disease Quality of Life (KDQOL)-36TM questionnaire. Self-reported physical activity level was assessed by International Physical Activity Questionnaires (IPAQ).
 Results: Quality of life in burden of kidney disease categories is different significantly between hemoglobin levels group (*p=0.034). There is significant difference between hemoglobin levels < 8 g/dL with 8.1–12 g/dL (**p=0.01) and hemoglobin levels < 8 g/dL with > 12 g/dL (*p=0.034). For self-reported physical activity, hemoglobin level was not associated with physical activity in Fisher’s exact test analysis (p=1.000).
 Conclusion: We found that hemoglobin levels > 8 g/dL were associated with higher quality of life in hemodialysis patient. Hemoglobin levels were not associated with physical activity. Recommended hemoglobin levels to support the best quality of life and physical activity without increasing mortality rate are still in need to be further evaluated.
Highlights
Chronic kidney disease (CKD) is still recognized as one of the major issues worldwide [1]
We found that quality of life in burden of kidney disease category was different significantly between hemoglobin levels group (*p=0.034) (Table 2)
We found that hemoglobin levels > 8 g/dL was associated with better quality of life
Summary
Chronic kidney disease (CKD) is still recognized as one of the major issues worldwide [1]. Since 2000, the prevalence of end-stage renal disease was 13,4% [4]. According to data from Global Burden of Disease Study (GBD), in 2015, the mortality rate of CKD has increased by around 32% since 2005 and reached 1.2 million globally [2,5]. Data showed that there were 2 million death cases of CKD because of the limited access in renal replacement therapy [6]. Hemodialysis in CKD is performed to replace kidney function in end-stage renal disease. It is frequently associated with complications such as hemodynamic disorders, arrhythmia, cramping, nausea and vomiting, headache, and anemia [8]
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