Why Hemodialysis Patients Struggle:Exploring the Causes and Life Impact of Anxiety and Depression
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Abstract
End-stage renal disease requires lifelong dialysis or transplantation, imposing substantial physical, emotional, and social limitations. Frequent hemodialysis (HD) disrupts daily functioning and is associated with anxiety, depression, poor quality of life (QoL), nonadherence, and adverse clinical outcomes. Given the global variation in chronic kidney disease epidemiology and anxiety prevalence in HD (12%–52%), this systematic review synthesizes recent evidence on the psychological effects of HD specifically anxiety and depression to identify influencing factors and interventions. Following the Preferred Reporting Items for Systematic reviews and MetaAnalyses guidelines and Cochrane Handbook for Systematic Reviews of Interventions, a January 2022 search across six databases (PubMed, Scopus, and Web of Science) and additional sources used terms for hemodialysis, anxiety, depression, psychological problems, and QoL. Peer-reviewed English studies were screened (2018–2023),
excluding non-empirical work and studies with substantial heterogeneity. From 693 records and 250 additional sources, 105 full texts were screened and 20 were included. Depression and anxiety were consistently prevalent.
In Northern China, 55.1% of 305 HD patients had depression and 25.9% anxiety; low income and comorbidities increased depression risk. Dialysis patients showed a greater psychological burden than transplant recipients, with depression threefold and anxiety 1.5-fold higher. Socioeconomic disadvantage, limited social support, education
and income gradients, stress, coping style (emotion-focused coping predicting better QoL), and physical health indicators were identified as correlates. Anxiety symptoms predicted higher mortality and hospitalization rates in the maintenance cohorts. Non-pharmacological interventions, including mindfulness and music therapy, reduced symptoms, with mindfulness benefits persisting for six months. Overall, routine psychological screening integrated into multidisciplinary nephrology care, alongside psychosocial and nonpharmacological interventions, is implicated in improving well-being and outcomes. Future
longitudinal and interventional studies should standardize screening and evaluate its longterm effectiveness.
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