<![CDATA[Anemia substantially increases morbidity, mortality, and healthcare burden in maintenance hemodialysis (HD) patients, necessitating precise risk stratification for optimal clinical management. This study evaluated demographic and readily accessible clinical parameters as independent predictors of severe anemia in an Indonesian HD cohort. A cross-sectional design was employed, enrolling 168 maintenance HD patients at Al Huda Hospital in Banyuwangi through purposive sampling. Severe anemia was strictly defined as hemoglobin <8 g/dL versus non-severe (≥8 g/dL). Data on age, sex, HD duration, and pre-dialysis oxygen saturation were systematically collected and analyzed using chi-square tests and multivariate logistic regression. The prevalence of severe anemia was 82.7%. Multivariate analysis identified female sex as the sole independent predictor of severe anemia (adjusted odds ratio [aOR] = 4.76; 95% confidence interval [CI]: 1.83–12.40; p = 0.001). Conversely, age (p = 0.393), HD duration (p = 0.328), and pre-dialysis oxygen saturation (p = 0.648) demonstrated no statistically significant associations with anemia severity. Female sex constitutes a robust independent risk factor for severe anemia in HD populations, strongly advocating for sex-specific hematological surveillance and individualized therapeutic protocols. The lack of predictive value for routine demographic and physiological parameters underscores the critical need to integrate comprehensive assessments of iron and inflammatory biomarkers into standard anemia management protocols to improve patient outcomes.]]>
