Cyberbullying involvement in adolescence: Associations with emotion regulation, metacognitive beliefs, loneliness, and perceived social support in a cross-sectional study.

Patients receiving maintenance dialysis are exposed to a substantial pill burden due to complex comorbidities and intensive treatment regimens [,]. The pharmacological management of end-stage kidney disease (ESKD) primarily involves antihypertensive agents, vitamin D supplements and phosphate binders [,]. Previous studies have reported a significant median (IQR) pill burden in CKD stage 5D of 122 (61) tablets per week []. Variations have also been observed across different modalities, with pill burdens differing between peritoneal dialysis (PD), home hemodialysis (Home-HD), and in-center hemodialysis (HD) []. The existing literature suggests that a high pill burden is strongly associated with increased treatment burden, reduced medication adherence, and impaired health-related quality of life (HRQoL) [,,]. While the physical act of managing polypharmacy contributes to treatment burden, optimal pharmacological therapy may paradoxically improve overall outcomes by reducing morbidity and stabilizing symptoms, thereby potentially maintaining or even enhancing HRQoL. Furthermore, the dialysis modality itself may significantly impact both treatment burden and HRQoL. Patients receiving PD may experience better HRQoL because treatment can be performed at home, allowing greater independence and reducing the need for frequent hospital visits. Within extracorporeal therapies, hemodiafiltration (HDF) has emerged as a superior alternative to conventional hemodialysis (HD) due to its enhanced clearance of middle molecules [], which may further influence the relationship between clinical morbidity and patient well-being.