Anaemia and health-related quality of life in patients on maintenance haemodialysis in Douala, Cameroon: a cross-sectional study

Background Anaemia is a frequent complication of kidney failure and may impair health-related quality of life (HRQoL), but data from sub-Saharan Africa, where access to erythropoiesis-stimulating agents (ESA) is limited, are scarce. We assessed the prevalence of anaemia, its association with HRQoL, and the factors associated with poor HRQoL among anaemic patients on maintenance haemodialysis in Douala, Cameroon. Methods We conducted a cross-sectional analytical study from January to May 2026 in the haemodialysis units of the Douala General Hospital and the Laquintinie Hospital of Douala. Consenting adults on maintenance haemodialysis were enrolled consecutively. Anaemia was defined as a mean haemoglobin (Hb) of the last three monthly measurements < 10 g/dL. HRQoL was assessed with the Kidney Disease Quality of Life Short Form (KDQOL-SF); an overall score < 50 defined poor HRQoL. Results Of 253 patients analysed (median age 50 years [IQR 42–60]; 41.1% women), 199 had anaemia (78.7%; 95% CI 73.2–83.3). Only 52.3% (n = 104) of anaemic patients were receiving an ESA, whereas 54.8% (n = 109) had been transfused. Anaemic patients had lower overall KDQOL-SF scores (median 51.6 vs 56.9; p = 0.003) and SF-36 composite scores (45.0 vs 56.2; p < 0.001), mainly in physical, general health and social domains. Poor HRQoL was more frequent among anaemic patients (41.7% vs 24.1%; adjusted odds ratio [aOR] 2.22, 95% CI 1.09–4.51), and each 1 g/dL decrease in Hb was associated with 38% higher odds of poor HRQoL (aOR 1.38, 1.17–1.63). Among anaemic patients, poor HRQoL was independently associated with pallor (aOR 3.41, 1.16–10.06), pre-dialysis blood pressure ≥ 140/90 mmHg (aOR 2.41, 1.10–5.26) and inversely associated with serum phosphate > 45 mg/L (aOR 0.43, 0.22–0.86). ESA use was associated with lower odds of poor HRQoL in bivariable analysis (OR 0.50, 0.28–0.88) but not after adjustment. Conclusions Anaemia affected about four in five patients on haemodialysis in Douala and was associated, in a graded manner, with poorer HRQoL, mainly in its physical dimensions. Improving access to ESA and iron therapy, together with better blood pressure control and regular HRQoL assessment, should be priorities for haemodialysis care in Cameroon.