Anxiety factors during dialysis and their management

Like all chronic conditions, chronic renal failure (CHF) is associated with the appearance of signs of depression and anxiety as the patient is asked to adapt to a new lifestyle. This new lifestyle is characterized by changes in the patient’s and his family’s everyday life, constraints in nutrition and water consumption, and changes in the patient’s role in the family or in a personal relationship. The patients also experience feelings of vulnerability, weakness and dependence by the medical or the nursing staff.

  • A high percentage of patients undergoing dialysis show symptoms of depression periodically, while 5-20% of them are diagnosed with major depression. In addition, the rate of anxiety disorders is estimated to be between 10-50%, without having been adequately studied, while insomnia seems to reach almost 80%. In addition to insomnia, depression and anxiety are expressed both behaviorally as well as in the form of various thoughts that overwhelm the patient. More specifically, the uncertainty about the progression of the disease and the fear of death brings the patients into confrontation with existential anxieties and feelings, manifesting themselves with aggressive behavior towards familiar persons and the nursing staff of the dialysis center. Moreover, signs of anger and aggression, the “refusal” of the patient to accept his condition and to comply with the limitations in his daily life is a phenomenon that is usually transient and a subconscious defense mechanism.
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  • Factors aggravating the onset of anxiety and depression symptoms are income reduction, deterioration in living standards, changes in everyday life, sexual dysfunction, strict diet and constraints, unemployment, changes in appearance, reduction of leisure time, as well as the feeling that the patient should undergo dialysis three times a week. All the prementioned constitute the stressful factors that lead to reduced self-esteem, withdrawal and social isolation of the patient.
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  • The diagnosis and treatment of depression is particularly important, not only for the quality of life of the kidney patient, but also because it is an additional risk factor for increased morbidity. The patients often disguise these feelings from the doctors and the nursing staff of the dialysis unit, and as a result the support and help of the patient's families is crucial to them. More specifically, the support of the family and the social environment is an important factor determining the quality of life, and it is not uncommon for the family members of the patients to experience anxiety and depression due to the mental burden and the fear of losing their relatives.
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  • The need to address the psychological effects caused by the disease itself and from the therapeutic programs, as well as the need to improve the quality of life, make the psychological support of patients and their families important. Its positive or negative outcome depends on the personality of the patient and the support he receives from the medical, nursing staff, family and social environment.
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  • Within the framework of organized psychological support programs, therapeutic groups enlighten as to ensure the regular communication between staff and patients in order to build a satisfactory therapeutic relationship, organize treatment sessions for specific patient groups (chronic dialysis patients, patients undergoing peritoneal dialysis, patients on the waiting list to be transplanted or transplanted patients), brief and refer to self-help groups (kidney patients associations and their families), as well as advise on alternative ways of improving physical and psychosocial status, such as physical activity. 
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  • Eleni Soltaridou, Psychologist at Mesogeios Dialysis Centers Group
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  • Bibliography
  • 1.Julia Krikzoni: Diploma Thesis - Investigation of the psychological adaptation of men and women to the artificial kidney. Postgraduate Study Programme - Mental Health Promotion - Prevention of Psychiatric Disorders - National and Kapodistrian University of Athens, School of Medicine, 2017.
  • 2.Daniela Comelis Bertolin, Ana Emilia Pace, Luciana Kusumota, Rita de Cássia Helú Mendonça Ribeiro: Ways for people on hemodialysis to deal with stressors: a literature review. ActaPaulEnferm 2008;21 (NúmeroEspecial):179-86.
  • 3. P. Chondrogiannis, P. Kalliakmani, N. Germanos, D. Datsikas, A. Stamati, V. Thanopoulou, D. Goumenos, K. Assimakopoulos: Depression, anxiety and their association with the levels of somatic pain in a patient on haemodialysis., Hellenic Nephrology 2014; 26 (3): 239-242.
  • 4.Francesca Taylor, Dr Gill Combes: Supporting the emotional and psychological needs of endstage renal disease patients, University of Birmingham, August 2014.
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