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THE IMPACT OF HEMODIALYSIS ON THE QUALITY OF LIFE OF
END-STAGE RENAL DISEASE PATIENTS: A STUDY OF
ADAPTATION AND TREATMENT CHALLENGES
Abdujabborov Jamshidbek
Omonov Jamshid
Tursunboev Ulugbek
Kushboeva Shabnam
Abdurakhmanova Sayyora
https://doi.org/10.5281/zenodo.15192865
Introduction.
Chronic kidney disease (CKD) is a prevalent and life-
threatening condition that significantly impacts the health of individuals. As CKD
progresses to end-stage renal disease (ESRD), patients are often required to
undergo renal replacement therapy (RRT), such as hemodialysis (HD), to sustain
life. The advent of modern dialysis methods has led to a substantial increase in
life expectancy for ESRD patients, extending it by an average of 10–12 years.
However, despite the improvement in medical outcomes, the prospect of lifelong
dialysis treatment presents various psychological and social challenges for
patients. Dialysis is often perceived as the end of life by patients, leading to
significant emotional distress. The concept of “quality of life” (QoL), introduced
by D.R. Elkinton in 1966, has become an essential measure for assessing the
impact of chronic diseases such as CKD on patient well-being. This study aims to
explore the quality of life of patients undergoing hemodialysis, particularly
focusing on how factors such as treatment duration and social adaptation affect
QoL.
Materials and Methods.
The study was conducted at the Republican
Specialized Scientific and Practical Medical Center for Nephrology and Kidney
Transplantation, involving 100 patients diagnosed with ESRD and undergoing
hemodialysis. The median age of participants was 55.2 years, with a range from
27 to 77 years, consisting of 47 men and 53 women. The most common causes of
ESRD included chronic glomerulonephritis (65%), diabetes mellitus (31.7%),
and polycystic kidney disease (3.3%). The average duration of hemodialysis
treatment among participants was 6.8 years. The quality of life was assessed
using the SF-36 questionnaire, a widely recognized tool that evaluates physical
and mental health across eight domains: physical functioning, role-physical
functioning, bodily pain, general health, vitality, social functioning, role-
emotional functioning, and mental health. Scores for each scale range from 0 to
100, with higher scores indicating better quality of life. The study also
categorized patients based on the duration of their dialysis treatment: up to 1
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year, 2-10 years, and more than 10 years, to investigate how treatment duration
impacts their overall well-being.
Results.
The results revealed significant differences in quality of life scores
between male and female patients. Women reported higher general health (GH)
scores (p<0.01), while men scored better in the social functioning (SF) domain
(p<0.05). However, overall physical and mental health indicators did not differ
significantly between genders. When comparing quality of life across different
dialysis durations, the first group (patients undergoing dialysis for less than 1
year) showed the lowest scores, particularly in physical role (RP) and emotional
role (RE) functions (p<0.01). These patients were more likely to report poor
physical health, emotional stress, and difficulty adjusting to the treatment.
Conversely, the second group (2-10 years of dialysis) demonstrated better QoL
outcomes, reflecting a period of adaptation, increased social integration, and a
more stable emotional state. The third group (dialysis duration exceeding 10
years) exhibited a decline in QoL, particularly in physical functioning and
emotional well-being, indicating that long-term dialysis patients often
experience complications, increasing pain, and reduced physical activity.
Notably, 81% of patients reported that the inability to travel was a major
stressor, and 74% expressed concern about fluid intake restrictions.
Discussion.
The findings of this study align with existing literature, which
suggests that the quality of life for patients on hemodialysis is significantly lower
compared to healthy individuals. The most notable determinants of QoL in these
patients are related to the duration of dialysis and the adaptation process.
Patients who are newly initiated into dialysis tend to experience severe
emotional distress, primarily due to the abrupt lifestyle changes, dependency on
medical equipment, and fears regarding the future. Over time, as patients
become more accustomed to the treatment, their physical and mental health
improves, though many continue to face challenges such as pain, fatigue, and
limitations in daily activities. The results also highlight the critical role of social
functioning, with patients in longer-term dialysis often regaining better social
integration and coping mechanisms. However, the decline in quality of life
among patients who have been on dialysis for more than 10 years emphasizes
the importance of managing comorbidities and complications associated with
long-term treatment.
Conclusion.
This study concludes that while hemodialysis significantly
improves survival rates for ESRD patients, it presents considerable challenges to
their quality of life. The findings underscore the importance of providing
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comprehensive support to patients, especially during the initial stages of
dialysis, to improve their mental health and adaptation. Educational programs
such as “Hemodialysis Schools” can assist in reducing anxiety and depression by
offering patients detailed information about the disease and treatment options.
Furthermore, developing tailored dietary plans and involving multidisciplinary
healthcare teams can help manage the physical and psychological impacts of
long-term dialysis. Future research should explore strategies to mitigate the
long-term effects of dialysis on QoL, particularly in older patients or those with
multiple comorbidities.
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