Twice vs Thrice Weekly Hemodialysis: Clinical Outcomes and Quality of Life

Inclusion Criteria: * \- Age 18 years or older * Established end-stage kidney disease requiring maintenance hemodialysis * Receiving in-center maintenance hemodialysis at Assiut University Hospitals * On maintenance hemodialysis for at least one month before enrollment * Established twice-weekly or thrice-weekly schedule prescribed by the treating team * Clinically stable at recruitment * Able to understand and respond to the questionnaire * Written informed consent Exclusion Criteria: * \- Acute kidney injury without established end-stage kidney disease * Hemodialysis for less than one month * Peritoneal dialysis or kidney transplantation during follow-up * Acute severe illness requiring intensive care at recruitment * Severe cognitive, psychiatric or neurological impairment preventing reliable questionnaire responses * Active malignancy with expected survival too short to complete follow-up * Temporary dialysis solely for an acute indication * Refusal to participate * Permanent transfer to another dialysis center during follow-up