Around the middle of the 20th century, dialysis appeared as a safe and efficient form of renal replacement therapy for those patients with kidney failure. Being capable of extending the life of multiple individuals who previously only had death as an answer, dialysis arrived with its life-sustaining function to bring hope for them.
Even though dialysis produces a significant and positive increase in the patients´ function and life expectancy compared to no treatment, some major complications need to be addressed such as the psychological effects the treatment process generates not only to the patient, but also to the family and social group that surrounds patients. Depression is quite common among patients with kidney disease and particularly so among patients with kidney disease on dialysis. Knowing what the causes are and the strategies that are known to help can improve outcomes for patients
It is important to note that in this article, the psychological complications produced by the kidney disease per se will not be discussed, instead, only the mental ramifications that come from the long term use of the dialysis machine, such as depression, mental stress, low quality of life, and related symptoms, will be talked about. At the end of the article, a list of possible solutions or tips will be provided in order to enable readers cope with these psychological factors and try to adopt dialysis into the day-to-day life as best as possible.
Chronic kidney disease is known for its capacity to progressively debilitate all the systems of the human body. Even if dialysis therapy prevents the rapid establishment of these systemic complications, it is only a matter of time for renal failure to decide the patient´s destiny.
In fact, the decisive nature of this chronic disease is one of the main factors that produce so many psychological problems to these patients, because, in the end, dialysis is only a treatment with a limited fix to many of the complications to the disease. Kidney transplant is a more final solution, but the opportunity of meeting the clinical, social and financial criteria for receiving a kidney transplant are very challenging, which increases the mental stress of remaining on dialysis treatment.
As a result of renal failure, depression is considered to be the most common psychological complication affecting these patients. This is strongly attached to low self-esteem and confidence, especially if the patient was previously highly functional and now feels like being a burden for the people around them. Pessimistic statements about the disease, feelings of loss of self worth, diminished concerns regarding personal appearance, reluctance to make decisions, and increased social isolation are some of the factors that accompany depression.
Clinical experience suggests that these patients and relatives exist in a world of mental stress, living and coping with a chronic disease that is associated with episodes of acute and often life-threatening events. Of course, in the long run, mental stress is worsened by the huge financial burden that kidney failure and the dialysis treatment entails.
Anxiety and panic symptoms also can appear in both the patients and the surrounding family and social group, presenting clinical signs, such as palpitations, breathlessness, chest pain, sweating, and fear of dying.
In addition, having to be attached to a machine for several hours a week in order to live is in itself an unexpected event in most people´s lives. Obviously, this produces a diminished quality of life, which gets even more aggravated when other factors like sleep and sexual dysfunction problems appear.
Strategies to reduce depression and anxiety associated with kidney disease and dialysis
Considering the above, several studies have demonstrated the effectiveness of some medical interventions to cope with these psychological complications, such as:
- Seeking an understanding and professional team of healthcare providers that have experience in the care of patients with kidney disease. There is no shame in telling your doctor that you are stressed out or depressed. Your team should be understanding and know what to do to help.
- Pharmacological treatment, which is mainly based on selective serotonin reuptake inhibitors (SSRIs), has been very useful for dialysis patients with depression or anxiety due to its low side effects profile compared to other pharmaceutical options.
- Psychotherapy is recommended for a wide range of chronic diseases, kidney disease included, improving sleep quality, fatigue, depression, and anxiety.
- Social support and education to both patients, family and friends involved may be helpful to improve emotional disturbances. These methods should be based on improving the patient’s social life, using the option of familiar and marital counseling, and increasing the involvement of the community.
- A proper nutritional plan should be designed for every single dialysis patient, including products that not only enhance energy levels, but also improve general health.
- Performing regular exercise programs may have a beneficial effect on these patients.
- Reaching out to friends and family to help relive stresses of the situation as necessary. Getting help at home to do things that might be too difficult, getting a partner to exercise with, visiting friends, talking with other dialysis patients and seeking support where available with financial challenges helps improve general mood and reduce anxiety.