One article to understand｜Psychological problems and coping measures for hemodialysis patients

The kidneys of patients with end-stage renal disease cannot effectively filter waste and excess fluid from the body, and renal replacement therapy is required. Hemodialysis, as the most commonly used renal replacement method, has saved the lives of countless patients with end-stage renal disease. However, long-term "torture" of kidney disease and hemodialysis may lead to a series of changes in the patient's psychological state.

In the early days of diagnosis, people with kidney disease may not believe they are really sick or try to deny the seriousness of the disease. This stage may be accompanied by worry, anxiety and fear. As the disease progresses, people may feel frustrated and angry, especially when they begin to experience obvious symptoms of decreased kidney function, such as fatigue, edema and high blood pressure. Such emotions may lead to emotional fluctuations and anxiety about the future. Over time, some people gradually accept the facts of the disease and try to adapt to a new lifestyle. They may seek medical advice on how to manage the disease, including medication and diet control.

When kidney disease deteriorates further and hemodialysis treatment is needed, it will cause anxiety and uneasiness in patients, because it involves long-term treatment and requires some major adjustments in life. When patients begin hemodialysis treatment, they usually go through an adaptation period. This stage may be accompanied by anxiety, uneasiness and fear of hemodialysis treatment. According to statistics, the psychological disorders of depression, anxiety and fear in patients before hemodialysis are as high as more than 97%. They have doubts about the doctor's diagnosis and hemodialysis treatment plan, and even deny and refuse. Over time, the patient's body gradually adapts to hemodialysis treatment, and begins to understand hemodialysis treatment. The feeling of uneasiness and fear will be alleviated. However, at this time, you may feel a certain degree of physical discomfort, such as fatigue, low blood pressure, nausea, etc., and these symptoms will not be alleviated until some time later. Over time, patients begin to adapt to the rhythm and process of treatment, learn to better self-manage the disease and treatment, and begin to accept hemodialysis treatment emotionally. However, long-term hemodialysis may still bring psychological challenges. The most common ones are pessimism and disappointment, living from day to day, being very depressed, being indifferent to everything, and thinking that they are just wasting their time; they are afraid of worsening of their condition and complications from dialysis, and they are afraid of the pain of multiple punctures. In addition, dialysis treatment takes a lot of time and may limit their activities. Patients may feel socially isolated; financial pressure, employment problems, and challenges in family and interpersonal relationships may also increase the psychological burden.

Therefore, it is necessary to pay attention to the mental health of hemodialysis patients.

1. Before starting dialysis treatment, guide patients to treat the disease correctly through health education. Explain the necessity of hemodialysis to patients and answer their questions to enhance their enthusiasm for participation and reduce their fear of hemodialysis.

2. Cultivate the patient's confidence in disease treatment, actively intervene in the adverse reactions in hemodialysis treatment, and adjust the patient's physical and psychological discomfort during treatment. **Successful treatment cases of similar diseases can be explained to the patient to enhance the patient's confidence in treatment.

3. Fully communicate with hemodialysis patients, increase humanistic care, help patients build up their psychological strength, and improve their compliance with hemodialysis treatment. Encourage patients to have a long-term struggle with the disease, and let them see that with the development of dialysis technology, the survival time of hemodialysis patients is constantly extended, and the quality of life can also be guaranteed.

4. Family members’ behavior and words have a certain impact on the patient’s psychology and treatment effect . Inform family members to participate in the patient’s psychological care and stabilize the patient’s psychology through family members.

5. Social support plays an important role in the psychological adaptation process of long-term hemodialysis patients. Positive interactions with friends and the medical team can help patients better cope with psychological challenges. Joining a support group or sharing experiences with other patients can also help reduce loneliness and anxiety.

6. For depression and anxiety in maintenance hemodialysis patients, drug therapy and non-drug therapy can also be chosen. At present, the guidelines recommend that selective serotonin reuptake inhibitors are the first choice for drug treatment. Non-drug treatment methods are safer and more effective, such as cognitive behavioral therapy, biofeedback therapy, exercise therapy, etc. In addition, traditional Chinese medicine treatment can also significantly improve the anxiety and depression of hemodialysis patients and improve the treatment efficiency, involving acupuncture therapy, acupoint application, abdominal vibration therapy, emotional therapy, five-tone therapy, and health-preserving qigong.

The psychology of patients undergoing long-term hemodialysis is complex. Patients go through an evolutionary process from the initial adaptation period to physiological adaptation, psychological adaptation and self-management, and their hearts are extremely fragile. Active social support, psychological care and education can help patients better cope with these changes, help them maintain physical and mental health and improve their quality of life.