en Nephrology Nephrology Meta-analysis Article <span style="font-size:13pt"><span style="text-justify:kashida"><span style="text-kashida:0%"><span style="text-autospace:none"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="font-style:italic"><b><span style="font-size:9.0pt"><span style="font-style:normal">Background: </span></span></b><span style="font-size:9.0pt"><span style="font-style:normal">Health‐related quality of life (HRQoL) is a key patient‐centered outcome in hemodialysis (HD) care, but sex‐related differences remain poorly quantified. This systematic review and meta‐analysis are focused on comparing HRQoL scores between female and male HD patients across generic (SF-36) and kidney‐specific (KDQOL-SF) domains.</span></span></span></span></span></span></span></span><br> <span style="font-size:13pt"><span style="text-justify:kashida"><span style="text-kashida:0%"><span style="text-autospace:none"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="font-style:italic"><span style="font-size:9.0pt"><span style="font-style:normal">&nbsp;&nbsp; <b>Methods:</b> This systematic review and meta-analysis followed PRISMA 2020 guidelines and was registered in PROSPERO (CRD420251078233). PubMed, Cochrane Library, Embase, and Google Scholar were searched for observational studies reporting HRQoL by sex in adult HD patients published from January 2000 to June 2025. Two reviewers independently screened studies, extracted data, and assessed risk of bias. Mean differences (Females&ndash;Males) were pooled using REML random-effects models (95% CI), heterogeneity was quantified using I&sup2; and the Q-test, and small-study bias was evaluated using funnel plots and Egger&rsquo;s regression.</span></span></span></span></span></span></span></span><br> <span style="font-size:13pt"><span style="text-justify:kashida"><span style="text-kashida:0%"><span style="text-autospace:none"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="font-style:italic"><span style="font-size:9.0pt"><span style="font-style:normal">&nbsp;&nbsp; <b>Results: </b>Nineteen studies (N=6025; 2713 female, 3312 males) were included. In SF-36 domains, females scored lower than males across all eight scales, most notably in Bodily Pain (</span></span><span style="font-size:9.0pt">P</span><span style="font-size:9.0pt"><span style="font-style:normal"><0.001), Role-Physical (</span></span><span style="font-size:9.0pt">P</span><span style="font-size:9.0pt"><span style="font-style:normal"><0.001), and Physical Functioning (</span></span><span style="font-size:9.0pt">P</span><span style="font-size:9.0pt"><span style="font-style:normal"><0.001). Egger&rsquo;s test indicated small-study bias only for Bodily Pain and General Health. In KDQOL domains, females reported worse &ldquo;Symptoms and Problems&rdquo; (</span></span><span style="font-size:9.0pt">P</span><span style="font-size:9.0pt"><span style="font-style:normal">=0.0653) and &ldquo;Effects on Daily Life&rdquo; (</span></span><span style="font-size:9.0pt">P</span><span style="font-size:9.0pt"><span style="font-style:normal">=0.0087), with no other significant sex differences. </span></span></span></span></span></span></span></span><br> <span style="font-size:13pt"><span style="text-justify:kashida"><span style="text-kashida:0%"><span style="text-autospace:none"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="font-style:italic"><span style="font-size:9.0pt"><span style="font-style:normal">&nbsp;&nbsp; <b>Conclusion:</b> Female HD patients consistently experience poorer HRQoL than males across multiple SF-36 and select KDQOL domains. These findings highlight the need for sex‐sensitive interventions, such as tailored pain management and psychosocial support, to improve quality of life in females receiving HD.</span></span></span></span></span></span></span></span><br> &nbsp; Hemodialysis, HRQoL, Chronic kidney disease, SF-36, Sex-related differences 1506 1515 http://mjiri.iums.ac.ir/browse.php?a_code=A-10-9765-1&slc_lang=en&sid=1 Yerbol Onalbekov yerbol.onalbek@gmail.com 200319475328460095850 0009-0003-5174-7753 Yes LLP “Scientific Center for Professional Training”, Astana, Kazakhstan Zarema Gabdilashimova zarema.gabdilashimova@gmail.com 200319475328460095851 200319475328460095851 No LLP “Scientific Center for Professional Training”, Astana, Kazakhstan Sholpan Kadir sholpankadir6@gmail.com 200319475328460095852 0009-0001-5183-3171 No LLP “Scientific Center for Professional Training”, Astana, Kazakhstan