Towards a developmental view of end-stage renal disease

Although much study has been devoted to the psychological adjustment of patients treated for end-stage renal disease (ESRD), relatively little attention has been paid to developmental perspectives of the patient with ESRD. ESRD can be divided into four phases: the onset stage, an initial treatment phase, a maturity phase, and a stage of death and dying. The tasks confronted in each phase are dissimilar. The roles of compliance and the medical staff may change in each phase. In particular, the stresses of the maturity phase may be balanced in a complex, enmeshed, and precarious fashion. A developmental view implies that adaptive mechanisms at one stage may be maladaptive in others, and that relationships and ethical viewpoints may change radically as the response to the disease and its treatment progresses. The developmental phase must be taken into consideration when decisions are made in the care of patients with ESRD.