Dialysis is a life-sustaining treatment for patients with end stage renal disease (ESRD). It involves filtering toxins and excess fluid from the blood when the kidneys can no longer perform this function effectively. Patients undergo dialysis treatments 2-3 times per week, with each session lasting 3-5 hours. This is a demanding regimen that impacts all aspects of a dialysis patient’s life. Understanding how dialysis patients feel both physically and emotionally is important for healthcare providers to deliver compassionate, high quality care.
Physical Symptoms and Challenges
Dialysis is draining and can leave patients feeling washed out and fatigued afterwards. Common physical symptoms reported by dialysis patients include:
- Fatigue – This is one of the most frequently reported symptoms, with up to 91% of hemodialysis patients experiencing persistent fatigue. The dramatic fluid shifts and blood pressure changes during dialysis contribute to “dialysis fatigue.”
- Muscle cramps – Up to 55% of patients have painful muscle cramping during or after dialysis. This is from rapid fluid and electrolyte shifts.
- Headaches – Can occur after dialysis, reported by up to 30% of patients.
- Itching – Caused by skin irritation from dialysis access site and build up of toxins. Up to 84% of patients experience intermittent itching.
- Restless legs syndrome – Unpleasant crawling, tingling, or restless leg sensations experienced by up to 60% of dialysis patients.
- Insomnia – Difficulty sleeping affects up to 80% of dialysis patients and exacerbates fatigue.
- Loss of appetite – Up to 71% of patients have reduced appetite which contributes to malnutrition.
- Bone pain – Caused by renal osteodystrophy and calcium/phosphorus imbalance.
- Muscle cramps – Up to 55% of patients have painful muscle cramping during or after dialysis. This is from rapid fluid and electrolyte shifts.
Managing fluid and dietary restrictions between dialysis sessions can also be challenging:
- Fluid restriction – Most patients are limited to 1-1.5L of fluid intake per day to prevent fluid overload issues.
- Dietary restrictions – Limitations on intake of potassium, phosphorus, and sodium.
Furthermore, the dialysis procedure itself can be uncomfortable or painful, especially needle insertion into the vascular access site.
Emotional and Psychological Impacts
In addition to physical symptoms, dialysis also takes a heavy psychological and emotional toll. Frequent dialysis treatments make it difficult to work full time or participate in activities that provide meaning and enjoyment. Dialysis patients often experience:
- Depression – Estimated to affect 20-30% of dialysis patients.
- Anxiety – Up to 52% of patients report anxiety.
- Stress – Both emotional stress from lifestyle changes and physical stress from dialysis treatments.
- Boredom – From the tedious routine of dialysis treatments and frequent medical appointments.
- Anger or frustration – From activity limitations, dietary restrictions, and dependence on dialysis.
- Fear and uncertainty – About the future and vulnerability to health complications.
- Reduced motivation and feelings of worthlessness – From inability to work or participate in enjoyable activities.
- Social isolation – Treatment schedule interferes with travel, social events, and family activities.
- Sexual dysfunction – Reported by up to 82% of dialysis patients.
- Sleep disturbances – Insomnia from “dialysis hangover”, restless legs, stress and anxiety.
Furthermore, dialysis patients have a high symptom burden and impaired quality of life compared to the general population. They rate their physical health status as lower than patients with cancer or heart failure. Dialysis patients with depression have a 20% higher risk of hospitalization and death within 1 year compared to non-depressed dialysis patients.
Coping Strategies and Adjusting to Life on Dialysis
Despite the challenges, many patients are able to adapt and cope with dialysis through various strategies:
- Seeking social support – Developing relationships with other dialysis patients provides motivation and emotional support.
- Cognitive restructuring – Reframing thoughts to focus on the positive, such as dialysis allowing them to stay alive.
- Stress management – Techniques like meditation, deep breathing, guided imagery to induce relaxation.
- Engaging in enjoyable hobbies – Finding activities that can be done during dialysis such as reading, puzzles, or arts and crafts.
- Maintaining routine – Keeping a consistent schedule helps patients regain a sense of control.
- Counseling – Individual or group therapy to develop coping skills and address mental health issues.
With time, many patients report improved adjustment and ability to integrate dialysis into their lives:
- After 1 year on dialysis, 69% of patients rate their health-related quality of life as “good” or “very good”.
- Patients cite regaining strength, accepting their condition, and support from fellow patients as helping improve their well-being over their first year on dialysis.
- Most patients are able to resume enjoyable activities within the limits of their treatment schedule.
However, a subset of patients struggle to adjust even after years on dialysis, emphasizing the need for ongoing psychosocial support.
Conclusion
Dialysis sustains life for patients with ESRD, but also imposes substantial physical, emotional, and practical challenges. Common symptoms experienced by patients include fatigue, muscle cramps, appetite changes, and pain, as well as high rates of depression, anxiety, and stress. Coping strategies, social support, and healthcare interventions can help improve patients’ adjustment and quality of life. Recognizing the heavy symptom burden carried by many dialysis patients will allow providers to deliver more holistic, compassionate care.