Influencing factors and sex differences of life satisfaction in patients with chronic kidney disease: a national cross-sectional study in China - PMC Skip to main content An official website of the United States government Here's how you know Here's how you know Official websites use .gov A .gov website belongs to an official government organization in the United States. Secure .gov websites use HTTPS A lock ( Lock Locked padlock icon ) or https:// means you've safely connected to the .gov website. Share sensitive information only on official, secure websites. Search Log in Dashboard Publications Account settings Log out Search… Search NCBI Primary site navigation Search Logged in as: Dashboard Publications Account settings Log in Search PMC Full-Text Archive Search in PMC Journal List User Guide PERMALINK Copy As a library, NLM provides access to scientific literature. 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Learn more: PMC Disclaimer | PMC Copyright Notice BMJ Open . 2026 Apr 13;16(4):e096038. doi: 10.1136/bmjopen-2024-096038 Search in PMC Search in PubMed View in NLM Catalog Add to search Influencing factors and sex differences of life satisfaction in patients with chronic kidney disease: a national cross-sectional study in China Kun Shen Kun Shen 1 The Thirteenth People’s Hospital of Chongqing, Chongqing, China 2 Chongqing Geriatric Hospital, Chongqing, Chongqing, China Find articles by Kun Shen 1, 2, ✉ , Xinyan Ji Xinyan Ji 3 The First Clinical College, Chongqing Medical University, Chongqing, China Find articles by Xinyan Ji 3 , Yu Zhang Yu Zhang 4 School of Public Health, Chongqing Medical University, Chongqing, China Find articles by Yu Zhang 4 , Yan Cheng Yan Cheng 4 School of Public Health, Chongqing Medical University, Chongqing, China Find articles by Yan Cheng 4 , Xiaobing Xian Xiaobing Xian 1 The Thirteenth People’s Hospital of Chongqing, Chongqing, China 2 Chongqing Geriatric Hospital, Chongqing, Chongqing, China Find articles by Xiaobing Xian 1, 2 Author information Article notes Copyright and License information 1 The Thirteenth People’s Hospital of Chongqing, Chongqing, China 2 Chongqing Geriatric Hospital, Chongqing, Chongqing, China 3 The First Clinical College, Chongqing Medical University, Chongqing, China 4 School of Public Health, Chongqing Medical University, Chongqing, China Supplemental material: Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise. None declared. ✉ Dr Kun Shen; [email protected] Received 2024 Nov 3; Accepted 2026 Mar 20; Collection date 2026. Copyright © Author(s) (or their employer(s)) 2026. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group. This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: https://creativecommons.org/licenses/by-nc/4.0/ . PMC Copyright notice PMCID: PMC13084846 PMID: 41974550 Abstract ABSTRACT Objectives The purpose of this study was to investigate the factors influencing life satisfaction in patients with chronic kidney disease and to explore any sex differences. Thus, this provides a theoretical basis for improving the life satisfaction status of middle-aged and elderly patients with chronic kidney disease, as well as formulating prevention, treatment and intervention strategies. Design Based on the health ecology model, 22 potential influencing factors were identified at five levels. Subsequent analyses examined whether they impacted the life satisfaction of patients with chronic kidney disease and had varying effects on different sexes. Participants A total of 1422 patients with chronic kidney disease were included from the 2018 China Health and Retirement Longitudinal Study. Primary and secondary outcome measures The χ 2 test and multivariate logistic regression model were used to analyse the influencing factors of life satisfaction in patients with chronic kidney disease and their sex differences. Sensitivity analyses additionally supported the robustness of the results. Results Age, self-rated health, depressive symptoms, marital satisfaction, satisfaction with children, activities of daily living and pension were all significant influencing factors of life satisfaction in patients with chronic kidney disease (p<0.05). The impact of drinking on life satisfaction in patients with chronic kidney disease showed significant sex differences. Interestingly, male patients who consumed alcohol were more likely to report high life satisfaction, while male patients who smoked cigarettes were more likely to show low life satisfaction; however, this association was not found in female patients. Conclusions This study reveals that a combination of factors affects life satisfaction in patients with chronic kidney disease. Therefore, targeted prevention and intervention strategies should be carried out, with specific focus on females, individuals with poor self-rated health and those experiencing depressive symptoms from a multidimensional perspective. Keywords: Aged, Nephrology, NEPHROLOGY, Patient Satisfaction, Patients STRENGTHS AND LIMITATIONS OF THIS STUDY. A multivariate logistic regression analysis was employed to examine the factors influencing life satisfaction among patients with chronic kidney disease. Multiplicative interaction analysis was conducted to assess differential effects across sexes. Two sensitivity analyses were conducted to test the robustness of the primary findings. In spite of systematic design, the cross-sectional survey limits the establishment of causal relationships. Introduction Chronic kidney disease (CKD) is a global health issue characterised by renal injury or decreased renal function lasting over 3 months. 1 In 2017, CKD had a global prevalence of 9.1%, affecting about 700 million people and resulting in 1.2 million deaths. In 2019, the incidence of CKD in China was also high at 8.2%. 2 It is reported that the global prevalence and mortality of CKD are still rising rapidly, 3 and CKD is predicted to stand as the fifth leading mortality on a global scale by 2040. 4 A study analysed 31 regions and countries and found that the direct treatment cost of CKD was US$36 628 per person in the early stage and US$45 999 in the later stage, significantly impacting the family finances, medical resources and social development. 5 CKD is often accompanied by a variety of systemic diseases, leading to complications such as hypertension, anaemia, osteoporosis, muscle atrophy, loss of appetite, cognitive impairment and decreased immunity. 6 Furthermore, according to quantities of clinical data, CKD has been identified as a notable risk factor for a wide range of cardiovascular diseases, such as peripheral artery disease, venous thrombosis, arrhythmia, heart failure, coronary heart disease and stroke. 7 , 9 According to Shirazian et al , 20–25% of patients with CKD suffer from depressive symptoms. 10 These results all emphasise the negative impact of CKD on both physical and mental health, as well as on overall quality of life. Life satisfaction (LS) is a comprehensive cognitive evaluation of personal life and is widely considered a key measure of subjective well-being. In 1978, Shin and Johnson first defined LS as ‘a person’s overall assessment of life quality based on their own chosen criteria’. 11 Kim et al analysed data from 12 988 American adults over 50 years old and found that higher LS could lead to 21 positive health outcomes, with the incidence of depression declining by 46%, physical function limitation decreasing by 25%, and a 26% reduction in the risk of death. 12 Therefore, in-depth research on the factors influencing LS is of great significance to improving human physical, psychological and behavioural health as well as overall well-being. Previous studies have confirmed that LS is influenced by a range of factors, encompassing daily life activities, health status, cognitive ability, depression, ageing, parenthood, marital status, social support, etc. 13 , 15 However, the impact of these factors on middle-aged and elderly Chinese patients with CKD is still unknown. Long-term research has demonstrated that patients with chronic diseases are limited by the physiological effects of the disease, treatment burden, psychological stress and social support, leading to low LS. 16 Yapa et al found that CKD carries a substantial symptom burden, which dramatically affects health-related quality of life. 17 Haemodialysis (HD) is a major way of kidney replacement therapy for patients with CKD, and earlier research has indicated that the LS and happiness of HD patients are notably lower than those of the general inhabitants. 18 Therefore, studying the factors influencing LS in patients with CKD to enhance their LS is more than significant. A global survey revealed that sex plays a significant role in determining LS. 19 Zhang et al conducted a comprehensive study, visiting nearly 16 000 families in 31 provinces (municipalities and autonomous regions) in China, and found that women tend to have higher LS than men. 20 Exploring sex differences in LS not only facilitates individuals to better understand their needs and expectations but also empowers them to make more choices that contribute to improving their LS. 21 Furthermore, it enhances the relevance and effectiveness of health, work welfare and social security policies. 22 In addition, the health ecology model emphasises the multi-level interaction between environment and individual health, as well as the complexity of influencing factors, 23 which is increasingly applied to the intervention and management of chronic diseases. 24 This model holds potential value for studying the association between multidimensional and multi-factors and LS in patients with CKD. Based on the China Health and Retirement Longitudinal Study (CHARLS) database and health ecology model, this study comprehensively investigates the influencing factors and sex differences in LS among middle-aged and elderly patients with CKD in China. The results of this study will further help improve the well-being of patients with CKD and promote the formulation of relevant public health measures and the progress of social harmony. Materials and methods Study design and data collection This study conducted a cross-sectional survey using the fourth wave data of the CHARLS in 2018. As a comprehensive survey project led by Peking University and Wuhan University, CHARLS gathers high-quality information from 23 Chinese provinces about households and individuals aged 45 and above. The sample size is substantial, and the data are highly representative and reliable, which are available by registering on the CHARLS official website ( https://charls.pku.edu.cn/ ). 25 Containing a broad range of information, including personal details, family composition, financial support, health status, medical care usage, insurance coverage, employment status, retirement, income, spending, property ownership and more, these data have been extensively used and acknowledged within the academic community. 26 , 28 Overall, 19 816 participants from the CHARLS 2018 database were used in our investigation. The following criteria were taken into consideration for inclusion and exclusion: (1) a diagnosis of CKD; (2) full data on LS variables; and (3) no missing data on predictive variables. Finally, 1422 individuals participated in this study, and figure 1 shows the detailed data-cleaning procedure. Figure 1. A flow chart about data processing. CHARLS, China Health and Retirement Longitudinal Study. Open in a new tab Measurement of CKD The determination of CKD was based on the participant’s report of physician diagnosis (‘Have you been diagnosed with kidney disease (except for tumor or cancer) by a doctor?’). 29 30 Participants who responded ‘yes’ were categorised as having CKD. Measurement of LS LS was assessed using a single-item measure: ‘To what extent are you satisfied with your overall life?’. Responses were recorded on a 5-point Likert scale (1=completely satisfied, 2=very satisfied, 3=somewhat satisfied, 4=not very satisfied, 5=not at all satisfied. 31 Consistent with prior research, responses of 1–3 were categorised as ‘satisfied’ and 4–5 as ‘not satisfied’. 32 Measurement of covariates To thoroughly investigate the factors affecting the LS of patients with CKD, a comprehensive exploration using the five dimensions of health ecology theory (including demographic factors, behavioural and psychological factors, family and social network factors, living condition factors and social policy factors) was conducted. Finally, 22 possible latent factors were identified from CHARLS. The details of variables are as follows, and online supplemental table 1 shows the assignments of all variables. Demographic factors: age, sex, nationality and self-rated health. Behavioural and psychological factors: hypertension, diabetes, dyslipidaemia, stroke, smoking, drinking and depressive symptoms. Family and social network factors: married status, marital satisfaction, children’s satisfaction and social activities. Living condition factors: education level, activities of daily living (ADL), instrumental activities of daily living (IADL), residence and living arrangement. Social policy factors: pension and insurance. Among these covariates, to evaluate depressive symptoms, the 10-item Center for Epidemiological Research Depression Scale-10 was used, which is a widely employed tool for screening such symptoms in Chinese middle-aged and elderly individuals. 33 34 Participants were queried regarding the frequency of their experiences over the past week, encompassing feelings of being bothered by things, difficulty concentrating, depression, exertion, hopefulness about the future, fearfulness, restless sleep, happiness, loneliness and inertia. After reversing the scores for the two positively worded items, we assigned a score ranging from 0 to 3 for each item using the following criteria: 0 for 0 days, 1 for 1–2 days, 2 for 3–4 days and 3 for 5–7 days. A final score (ranging from 0 to 30) was then calculated based on the scores for the ten questions, and ≥10 was determined as depressive symptoms. The question ‘Have you engaged in any of these activities in the past month?’ was employed to inquire information about social activities, such as socialising with friends, doing voluntary or charitable work, using the internet and participating in other forms of social activities. If the participants did not participate in the activities above, they were assumed to have no social activity. 35 To determine ADL disability, a 6-item version of Katz was used. Participants reported the ability to participate in dressing, bathing or showering, eating, getting in and out of bed, using the restroom and bowel and urine control. If they had difficulties in at least one of them, they were considered to have ADL disability. 36 IADLs include cleaning, cooking, grocery shopping, taking prescriptions and handling finances. Similarly, each item was classified into two categories, and people with at least one of them were identified as IADL disability. 37 Statistical analysis Categorical variables were described as frequencies and percentages (n%). Differences in baseline characteristics and LS by sex were assessed using the χ 2 test. To identify the influencing factors of LS in patients with CKD, a multivariate logistic regression model was constructed. In this model, LS served as the dependent variable, with sex and other relevant variables included as covariates. A multiplicative interaction analysis between sex and other covariates was incorporated to examine potential effect modification. Model calibration was evaluated using the Hosmer-Lemeshow goodness-of-fit test. The variance inflation factor (VIF) was calculated to assess multicollinearity among all included covariates; the absence of severe multicollinearity (all VIFs<10) ensures that the model provides reliable estimates for evaluating the independent effect of each variable while adjusting for others. After identifying the influencing factors, a directed acyclic graph (DAG) analysis was constructed to visualise the complex relationships among all variables and to illustrate the potential roles. Besides, two sensitivity analyses were conducted to test the robustness of the primary findings: (1) Multiple Imputation by Chained Equations (MICE) was applied to impute missing values for individuals with less than 20% missing data, after which the logistic regression analysis was repeated; (2) a more robust proportional odds ordinal logistic regression model was used as an alternative to re-analyse the influencing factors of LS in patients with CKD. All statistical analyses were performed using R V.4.3.0, and p<0.05 was considered statistically significant. Results Results of descriptive analysis Online supplemental table 1 presents the sociodemographic features of patients with CKD. A total of 1422 participants were analysed, comprising 633 females (44.5%) and 789 males (55.5%). On demographic factors, participants aged 60 years and above accounted for more (76.44%). The self-rated health of 645 participants (45.36%) was general, 630 participants (45.36%) were poor and only 147 participants (10.34%) were good. In terms of behaviour and psychology, most participants did not smoke (98.45%), did not drink (65.54%) and did not have hypertension (87.90%). More than half of the participants suffered from depressive symptoms (50.35%). As for family and social network factors, 89.24% of participants were married, with 88.47% reporting satisfaction with their marriage. Participants engaged in social activities (55.34%) were slightly higher than those without (44.66%). In terms of living condition factors, participants with primary school diplomas were the most (46.62%), followed by those with secondary school diplomas or above (37.48%). 73.70% of the participants had no difficulty in ADL, and 67.72% had no difficulty in IADL. Considering social policy factors, most participants had no pension (77.29%). The influencing factors of LS in patients with CKD Multivariate logistic regression results are displayed in online supplemental table 3 . Age, sex, self-rated health, depressive symptoms, marital satisfaction, satisfaction with chilidren, ADL and pension were significant influencing factors of LS in patients with CKD. In terms of demographic factors, patients aged ≥60 years were less likely to express low LS than those aged 45–60 years (OR=0.46, 95% CI 0.31 to 0.68), and female patients were less likely to feel low LS than male patients (OR=0.66, 95% CI 0.47 to 0.91). Patients with general and poor self-rated health were more likely to be unsatisfied with their lives than those with good self-rated health (OR=3.87, 95% CI 1.26 to 11.92) (OR=5.72, 95% CI 1.86 to 17.65). Regarding behaviour and psychology factors, patients with depressive symptoms were likely to express low LS than those without depressive symptoms (OR=4.67, 95% CI 3.00 to 7.27). In terms of family and social network factors, patients who reported being satisfied with their marriage and their children had a higher LS than those who were not satisfied with their marriage and children (OR=0.26, 95% CI 0.17 to 0.40), (OR=0.22, 95% CI 0.13 to 0.40). In terms of living condition factors, patients with ADL disability demonstrated a higher probability of low LS (OR=1.51, 95% CI 1.01 to 2.27). Regarding social policy factors, patients with pensions were less likely to show lower LS than those without pensions (OR=0.47, 95% CI 0.26 to 0.84). Differences in influencing factors on LS in patients with CKD between male and female. The χ 2 test results in online supplemental table 4 indicated significant differences in LS among male patients with CKD in different self-rated health, drinking, dyslipidaemia, depressive symptoms, marital satisfaction, satisfaction with children, ADL, IADL and pension. The LS of female patients with CKD was significantly different in different self-rated health, depressive symptoms, marital satisfaction, satisfaction with children, residence, ADL, IADL and pension. The findings from the multivariate logistic regression analysis are detailed in online supplemental table 5 . Age, self-rated health, marital satisfaction, satisfaction with children, smoking, drinking, pension and depressive symptoms are significant factors affecting the LS of male patients with CKD. Compared with each reference group, the odds of low LS was reduced in patients with CKD aged ≥60 years (OR=0.36, 95% CI 0.19 to 0.68), satisfied with marriage (OR=0.19, 95% CI 0.09 to 0.42), satisfied with children (OR=0.36, 95% CI 0.09 to 0.46), drinking (OR=0.54, 95% CI 0.35 to 0.84) and owning a pension (OR=0.41, 95% CI 0.18 to 0.91). On the contrary, poor self-rated health (OR=4.78, 95% CI 1.15 to 19.92), smoking (OR=2.95, 95% CI 1.01 to 8.63) and having depressive symptoms (OR=4.16, 95% CI 2.27 to 7.63) increased the odds of low LS. In addition, the results showed that among female patients with CKD, age, self-rated health, marital satisfaction, satisfaction with children, depressive symptoms and ADL were significant influencing factors of LS. Among them, those aged ≥60 years old (OR=0.53, 95% CI 0.30 to 0.91), satisfied with marriage (OR=0.30, 95% CI 0.18 to 0.52) and satisfied with children (OR=0.25, 95% CI 0.10 to 0.61) were less likely to report low LS, while poor self-rated health (OR=8.62, 95% CI 1.08 to 68.59), having depressive symptoms (OR=5.28, 95% CI 2.63 to 10.61) and ADL disability (OR=1.80, 95% CI 1.16 to 2.80) increased the probability of low LS. Additionally, there was a statistically significant interaction between drinking and sex, according to the interaction analysis shown in online supplemental table 5 . (B=0.859, p<0.05). The complex relationships among the variables were further visualised through DAG ( figure 2 ), and the potential role of each variable is shown in online supplemental table 6 . Figure 2. The DAG of all variables. ADL, activities of daily living; DAG, Directed Acyclic Graph; IADL, instrumental activities of daily living. Open in a new tab Sensitivity analysis Two sensitivity analyses were examined to evaluate the results’ robustness: (1) applying MICE to avoid information loss due to the deletion of missing data and (2) conducting proportional odds ordinal logistic regression to better retain the ordinal structure of the data. Results from all sensitivity analyses confirmed that age, self-rated health, depressive symptoms, marital satisfaction, satisfaction with children, ADL and pension were significant influencing factors of LS in patients with CKD ( online supplemental tables 7,8 ). Although the sex variable did not reach statistical significance in the ordinal regression retaining the original 5-point scoring, the direction of its effect was consistent with that in the binary logistic regression analysis (both suggesting that female patients with CKD were more likely to have higher LS than male patients). These analyses supported our primary findings and reinforced the stability and robustness of our conclusions. Discussion Based on the theory of health ecology, this study systematically explored the influencing factors of LS in middle-aged and elderly patients with CKD in China and conducted in-depth analysis under different sexes. The study revealed that female patients with CKD had lower odds of experiencing low LS compared with male patients. Although there is limited research on the impact of sex on LS in patients with CKD, our results support earlier research indicating that women typically have higher LS than men. 19 This difference may be attributed to women’s tendency to prioritise social participation, making them more resilient in the face of CKD challenges than men, who tend to be more independent. 38 Additionally, male patients with CKD demonstrated higher progression of the disease and cardiovascular mortality. 39 Therefore, severe symptoms and complications had a more detrimental effect on the everyday lives and physical health of male patients. Furthermore, patients aged 60 years and older had a 54% lower likelihood of low LS than those aged 45–60 years, aligning with Pretto et al ’s finding indicating that elderly patients with CKD tend to have a higher quality of life. 40 This result may be explained by the age maturity effect. As the age increases, older adults are more emotionally stable, 41 have better adaptability to CKD and are more able to predict and alleviate the adverse effects of the disease. Similar to the findings of previous studies, 42 lower LS is more prevalent in patients who feel poorly about their own health. Perhaps as a result of the higher prevalence of more severe renal symptoms in these patients, such as oedema, hypertension, anaemia, nausea, vomiting, etc. Or, as the disease reaches its middle and late stages when renal function is more severely compromised, the increased health burden and stressful lifestyle may lead to low LS. Research has consistently indicated that depressive symptoms significantly diminish LS, 43 and Kunwar et al ’s study also came to a similar conclusion, 44 which our study also validates. Depression has been associated with several adverse outcomes, including decreased social function, impaired mental health, treatment non-compliance and an elevated risk of infections and cardiovascular disease. 45 Furthermore, our findings suggest that patients with strong marital and children’s satisfaction showed a notable decline in the chance of low LS, which could be attributed to the fact that harmonious family relationships can promote individual physical and mental health, provide better medical care and life care, bring social and economic benefits, ultimately improving the quality of life for individuals with CKD 32 and increasing their LS. Khodabakhsh et al ’s study found that both ADL and IADL disability can reduce the LS of older adults as the obstacle of daily life reduces the possibility of participating in social interaction and activities, affecting the range of daily life activities. 13 Our study also found that ADL was an influencing factor of LS in patients with CKD, but no significant correlation was observed between IADL and LS. This might be because ADL disability encompasses the most basic and essential activities in daily life, while IADL disability involves more complex tasks. 37 Patients with CKD with IADL disability may receive support from family, community services or technological assistance to carry out these activities, thus buffering the negative impact of IADL disability. Pensions are also associated with better LS for older adults, which aligns with other research findings. 46 CKD is a chronic illness that requires long-term care and management, and patients frequently have to pay higher medical costs. 47 Pensions give elderly patients more stable financial security so that more disposable income can be used to improve their quality of life, thereby improving LS. Recent studies have found that moderate drinking can enhance people’s subjective well-being. A study conducted in Korea indicated that individuals who consumed light amounts (<15 g/day) and moderate amounts (15–29.9 g/day) of alcohol had a 21% and 17% lower odds of developing all-cause dementia, respectively. 48 Interestingly, our study also found that drinking can reduce the odds of low LS in male patients with CKD. This may be because moderate drinking can reduce the risk of cardiovascular events 49 and alleviate the pain experienced by patients with CKD. Sex disparities observed in the study may be due to variations in psychological resilience between men and women. When dealing with stress and challenges associated with CKD, men may be more inclined to seek comfort through material or behavioural satisfaction, such as drinking. 50 Therefore, drinking emerges as a significant determinant of LS in male patients. This study offers key insights for clinicians and policymakers. Clinically, it underscores the need for an integrated approach to assessing LS in patients with CKD, moving beyond biomedical metrics to routinely include psychological, functional and family relationship assessments. Screening for depressive symptoms and daily functioning should be standard, while leveraging satisfaction with marriage and children provides a practical avenue for family-based support. Implementing gender-sensitive care is essential—addressing the psychosocial aspects of behaviours like drinking in men and prioritising functional rehabilitation in women. For policy, the findings highlight the urgency of a multi-sectoral strategy to improve patient well-being. This includes integrating mental health support into standard CKD care and strengthening economic safety nets, such as pension coverage, to reduce financial insecurity. Public health initiatives must also be gender-responsive. Ultimately, incorporating patient-reported outcomes like LS into healthcare evaluations can catalyse a shift from disease-focused management to holistic well-being promotion, advancing healthy ageing. Limitations This study has several limitations to consider. First, cross-sectional design precludes causal inference and can only identify factors associated with LS in patients with CKD. Future research could employ longitudinal designs to examine causality. Second, though the assessment of LS using only a single item and the measurement of marital satisfaction through a dichotomous approach are both widely used in previous research, they may still be subject to measurement bias. More comprehensive and rigorously validated scales could be employed in further studies to enhance measurement precision. Most of the variables in this study (such as CKD, etc.) were measured by self-reports, which inevitably introduced recall bias and social desirability bias. Future research is expected to use more precise research methods to reduce bias. Additionally, the findings are based on Chinese adults aged 45 and above and may not generalise to younger populations or other regions. Conclusions This study explores the factors influencing LS and its sex differences among nationally representative middle-aged and elderly patients with CKD. We found that patients aged ≥60 years, female, satisfied with their marriage and children, and receiving pensions were more likely to report higher LS. Conversely, those reporting poor self-rated health, depressive symptoms and ADL disability were more likely to report lower LS. Additionally, we discovered that the effects of drinking on patients with CKD differed significantly by sex. These findings offer important insights for the implementation of targeted interventions to enhance the LS of middle-aged and elderly patients with CKD. Supplementary material online supplemental file 1 bmjopen-16-4-s001.pdf (2.7MB, pdf) DOI: 10.1136/bmjopen-2024-096038 Acknowledgements We thank each participant for their support of our study. At the same time, we would like to express our sincere thanks to the staff of the China Health and Retirement Longitudinal Study (CHARLS) database. Footnotes Funding: The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors. Prepublication history and additional supplemental material for this paper are available online. To view these files, please visit the journal online ( https://doi.org/10.1136/bmjopen-2024-096038 ). Provenance and peer review: Not commissioned; externally peer reviewed. Patient consent for publication: Not applicable. Ethics approval: This study involves human participants and was approved by the Research Ethics Committee of Peking University (IRB00001052-13074). Participants gave informed consent to participate in the study before taking part. Data availability free text: The data sets used and analysed in this study are available from the corresponding author upon request. And all data can be found in this link ( https://charls.pku.edu.cn/ ). 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