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The research was conducted in accordance with the Declaration of Helsinki and institutional ethical guidelines. All participants (or their parents\/guardians for minors) received a clear explanation of the study objectives and procedures, and written informed consent was obtained prior to participation. Participation was voluntary, and patients were assured of their right to withdraw at any time without consequences for their care. Given the vulnerability of patients undergoing hemodialysis, particular attention was paid to ensuring comprehension and minimizing burden. All data were anonymized before analysis to protect confidentiality. As this was a cross-sectional observational study without any intervention beyond routine clinical care, prospective trial registration was not required.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"97"}}