Hemodialysis treatment engenders anxiety and emotional distress


Anxiety is common in maintenance hemodialysis (MHD) patients. The extent to which anxiety is engendered by the dialysis treatment itself is not known. We investigated whether anxiety occurs with individual hemodialysis treatments and examined factors associated with these symptoms.

This was a cross-sectional study examining 246 MHD patients. Anxiety and other emotional distresses associated with hemodialysis treatments were examined with a questionnaire. Patients were also assessed with the Beck Anxiety Inventory (BAI) and Beck Depression Inventory (BDI).

Patients were 57 ± 15 (SD) years; 58% male, 46% diabetic, and undergoing MHD for a median of 40 months (range: 6 - 210 months). 32 - 51% of patients reported anxiety when coming to dialysis, hearing an alarm sound, being connected to the dialysis machine by a new person or seeing paramedics in the dialysis unit. 12 - 18% of patients experienced severe anxiety with one or more of these events. Dialysis-related anxiety correlated with severity of anxiety and depression as determined by BAI and BDI (p < 0.0001 for each comparison) but generally not with dialysis vintage. Even among patients with no or minimal anxiety according to BAI, 9 - 23% reported a little bit to moderate anxiety and 9 - 15% described quite a bit to extreme anxiety with hemodialysis treatments. The frequency that patients described distressing thoughts and feelings correlated directly with their degree of anxiety or depression as determined by BAI and BDI.

Patients commonly experience anxiety, which is often severe, with MHD treatments. Hemodialysis-induced anxiety is directed related to the presence and severity of underlying anxiety and depression. Hemodialysis-associated anxiety is prevalent and may be severe even in patients with minimal or no anxiety and/or depression, as determined by BAI and BDI. The frequency and severity of hemodialysis anxiety does not decrease with greater dialysis vintage except for a reduction in anxiety when hearing the dialysis machine alarm.
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