Abstract: Objective To analyze the latent classes of family resilience among young and middle-aged (18-59 years) patients on maintenance hemodialysis (MHD) and to explore their influencing factors. Methods This cross-sectional study recruited 412 eligible young and middle-aged MHD patients from multiple centers, including the First and Second Departments of Blood Purification at Hunan Provincial People's Hospital, the Hemodialysis Unit of Changsha First Hospital, and the Chenzhou Second People's Hospital, between October 2024 and March 2025. A general information questionnaire and the Chinese version of the Family Resilience Assessment Scale (C-FRAS) were used for the survey. Latent class analysis was applied to identify different categories of family resilience among the young and middle-aged MHD patients, and multivariate logistic regression was employed to analyze the influencing factors. Results Family resilience in this population could be classified into three latent classes: low resilience (208 cases, 50.5% ), moderate resilience (178 cases, 43.2%), and good resilience (26 cases, 6.3%). Using the good resilience group as the reference, multivariate logistic regression identified several protective factors: a higher education level (using college or above as reference; junior high school or below: moderate vs. high OR=1.132, 95% CI: 1.019～1.825, P=0.026; low vs. high OR=1.587, 95% CI: 1.120～8.195, P=0.023), lighter economic burden (using no burden as reference; lighter burden: moderate vs. high OR=4.392, 95% CI: 2.364～6.825, P=0.035), enrollment in employee medical insurance (using resident medical insurance as reference; moderate vs. high OR=3.654, 95% CI: 1.165～7.521, P=0.012; low vs. high OR=3.654, 95% CI: 1.123～4.574, P＜0.001), extroverted personality (using introverted as reference; moderate vs. high OR=0.245, 95% CI: 0.321～0.936, P=0.039), and shorter dialysis vintage (using ＜1 year as reference; 1～3 years: moderate vs. high OR=3.245, 95% CI: 2.962～4.954, P= 0.015; low vs. high OR=1.326, 95% CI: 1.121～7.829, P＜0.001). Conversely, a heavy economic burden (using no burden as reference; heavier burden: low vs. high OR=0.126, 95% CI: 0.012～0.687, P=0.049) was identified as a risk factor. Conclusion Family resilience among young and middle-aged MHD patients can be categorized into three latent classes. Clinical healthcare professionals should pay attention to the family resilience status of these patients and implement targeted intervention strategies to enhance their treatment adherence.

Key words: Young and middle-aged, Maintenance hemodialysis, Family resilience, Latent class analysis, Influencing factor