Acknowledgements: the authors would like to thank the staff and administration of the hemodialysis units in An-Naseria, Iraq, for their cooperation and support in accessing patient records. The authors also express gratitude to the College of Pharmacy, University of Thi-Qar, and Al-Ayen Iraqi University for providing logistical support.

Author contribution: Fatma M. Mostafa — conceptualization, study design, data collection, data analysis, manuscript drafting, and final approval; Sarah Jaafar Saadoon — data collection, visualization, review, and manuscript revision; Ammar Mohammed Atiyah — data interpretation, statistical analysis (SPSS), and critical revision of the manuscript; Ahmed H. Ibrahim — data validation, manuscript editing, and final approval.

Compliance with ethical standards: this retrospective study was conducted in accordance with the ethical standards, the research was approved by the Research Ethics Committee of Al-Ayen Iraqi University under approval number AUIQ-REC-2025-003. Due to the retrospective nature of this study using anonymized patient records, the requirement for informed consent was waived by the ethics committee.